7/11/2023 0 Comments One medical cobble hill![]() The state has launched its “long-awaited” (or long-feared, depending whom you ask) transition to NYRx, a fee-for-service Medicaid pharmacy benefit program that carves prescription drug coverage out of managed-care plans, Gov. NY State of Health will increase its customer service center staffing to above pre-pandemic levels to handle the anticipated volume, according to a Department of Health presentation. “It is our top priority to reinstate eligibility reviews in a way that retains coverage for as many enrollees as possible and limits coverage gaps, particularly for vulnerable populations dependent on services,” state Medicaid Director Amir Bassiri said in a statement in March.įor New Yorkers who are no longer Medicaid-eligible, the state’s health plan marketplace - NY State of Health - will help them transition to the Essential Plan, Child Health Plus or a qualified health plan. A spokesperson said the department is still in good-faith negotiations with the Centers for Medicare and Medicaid Services on its risk-mitigation plan for the unwind period. The Department of Health is also in talks with the federal government about using IRS data to conduct auto-renewals for some Medicaid members. The state has undertaken some efforts to prevent gaps in health coverage, such as by expanding Medicaid eligibility for New Yorkers with disabilities and those over 65. “To not have that health coverage is really catastrophic.”ĭrinkwater said MetroPlusHealth, which is part of NYC Health + Hospitals, has almost 339,000 members who will need to recertify eligibility before the end of this year. ![]() “We know that so many people can have one medical emergency that really derails their entire life from a financial perspective,” said Erin Drinkwater, chief of government relations and strategic partnerships for insurance carrier MetroPlusHealth. Now the stakes are even higher due to the sheer number of people going through the process at the same time. The first renewal deadline is June 30.īefore the pandemic, annual re-certifications were already a known point when many lose health coverage. In New York, however, Medicaid coverage terminations won’t start until July 1, according to the state Department of Health.Ĭonsumers are being encouraged to renew by the 15th of the month when their coverage expires. Medicaid enrollment would dip from about 7.8 million to under 6.5 million by next March as a result, according to those estimates, although that would still exceed the program’s pre-Covid enrollment of 6.1 million. Roughly 100,000 New Yorkers would be newly uninsured, according to preliminary estimates. ![]() New York state officials estimate that about 52,000 people will shift from Medicaid to Child Health Plus, 46,000 will move to the Essential Plan, and 54,000 will enroll in qualified health plans. The process to re-determine eligibility will be a massive undertaking for state and local governments: New York is embarking on the process of reviewing more than 9 million people across the state who are enrolled in Medicaid, Child Health Plus and the Essential Plan to see whether they still qualify for government-sponsored insurance. The result? An estimated 15 million of the nation’s 92 million Medicaid enrollees will lose coverage over the next 14 months, including roughly 7 million who are actually still eligible due to “ administrative churning.” The unwinding must be completed by the end of May 2024. This past weekend brought the end of continuous Medicaid coverage, under a Covid-related policy that prohibited states from removing any enrollees from their Medicaid rolls. Planning for the end of pandemic-era Medicaid coverage ![]()
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