Newton's third law of motion says that, 'for every action, there is an equal and opposite reaction.' And so, just as COVID-19 Public Health Emergency (PHE) sent shockwaves through the world of Medicaid between 2020 and 2022, so too did the Continuous Coverage Unwinding (CCU) in 2024 and 2025.
In the early stages of the PHE, Medicaid agencies and Medicaid MCOs were experiencing issues including, but not limited to, rapid reductions in utilization for certain providers and the potential implications on provider stability, uncertainty around treatment costs for COVID-19 cases, the impact of newly expanded telemedicine services on cost projections, and potential changes in Medicaid risk pool due to the impact of COVID-19 on the economy and the implementation of continuous coverage requirements.
Medicaid MCOs, state Medicaid agencies and CMS worked together to implement risk corridors and other mechanisms and accommodations to ensure the overall stability of the Medicaid program and then to adapt those strategies as the PHE evolved.
Similarly, during the lead up to the CCU, the potential for significant increases in the volatility of program costs, both in total and on a per member per month (PMPM) basis, were front and center in the minds of stakeholders across the Medicaid system.
In this session, we will bring together actuaries representing Medicaid MCOs, state Medicaid agencies and their actuarial consultants across multiple markets to discuss:
Themes in PHE and CCU risk mitigation strategies deployed across markets,
Similarities and differences of the actuarial challenges from the PHE and the CCU,
Which PHE-era risk mitigation strategies were more/less effective in achieving the goals of stabilizing the program,
Actuarial approaches to estimate the impact of the CCU,
How the experience from the PHE informed risk mitigation decision making heading into the CCU, and
Which new/unique risks arose in connection with the CCU that required consideration.
As appropriate, the list of topics to be discussed during this session will be adjusted to account for additional developments.