Citing Medicaid costs, GOP governors call for an end to pandemic public health emergency

Declaring that “we have returned to life as normal,” two-dozen Republican governors across the nation have called on President Joe Biden to end the federally declared public health emergency.

The emergency, or PHE, is tied to the COVID-19 pandemic and is scheduled to expire on Jan. 11, 2023, although Biden is expected to extend it into April 2023.

The Republican governors are urging the president to let the declaration expire in April. In the letter, they state their concern is the effect the declaration has had on increasing the number of people eligible for Medicaid – an expansion they say is “costing states hundreds of millions of dollars” as they help pay for beneficiaries’ medical care.

“It is time we move on from the pandemic,” the governors’ Monday letter argued. “The PHE is negatively affecting states, primarily by artificially growing our population covered under Medicaid, regardless of whether individuals continue to be eligible under the program. Since the beginning of the pandemic, states have added 20 million individuals to the Medicaid rolls, an increase of 30 percent, and those numbers continue to climb as the PHE continues to be extended every 90 days.”

Pennsylvanians who have had health insurance through Medicaid during the pandemic could begin to lose their coverage this coming spring under the proposed federal spending bill unveiled this week.

The congressional proposal would end the pandemic-era rule requiring states to continue covering Medicaid enrollees even if they no longer qualify under a state’s eligibility rules. The requirement was packed into federal coronavirus legislation passed in March 2020.

Under the terms in the $1.7 trillion spending package, millions of people could lose coverage nationally under a process that could start as soon as April 1 if Congress passes the federal spending bill.

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In Pennsylvania, advocates have pressed federal and state officials to find a way to extend coverage for millions of Pennsylvania children who have benefited from the enhanced Medicaid coverage.

The ranks of Pennsylvania’s uninsured children dropped between 2019 and 2021, from 4.6 percent to 4.4 percent, according to newly released research by the advocacy group Pennsylvania Partnerships for Children. That’s lower than the nationwide average of 5.4 percent, but still higher than surrounding states, according to the report.

Child enrollment in Medicaid increased by 20 percent during the pandemic, with more than 1.4 million children in the state relying on Medicaid as their source of health coverage, the research showed.

“We are cautiously optimistic about the improvement in our child uninsured rate in Pennsylvania,” Kari King, the group’s president and CEO, said in the statement.

But even with those improvements, “the number of uninsured children in the state totals the populations of Harrisburg and Scranton combined,” King continued, adding that “hundreds of thousands of children are at risk of losing … coverage when the public health emergency ends and the state begins to unwind the disenrollment freeze and resume pre-pandemic operations.”

Pointing to an analysis by the state Department of Human Services, the report asserts that as 1 in 4 kids now enrolled in Medicaid could lose coverage when the public health emergency ends, and the process to redetermine eligibility begins.

The report urges the state Department of Human Services to:

• “Reaffirm its commitment to using a 12-month unwinding period as recommended by the Centers for Medicare and Medicaid, which most other states plan to use. Using the full 12 months permitted will give Pennsylvania the best chance to minimize inappropriate terminations and disruptions in coverage (churn) that often impact children more than the adult population.
• “Immediately expand the 12-month continuous eligibility policy to children ages 4 through 21 in Medicaid when the public health emergency ends to make it more equitable—Pennsylvania already provides 12-month continuous eligibility (regardless of changes in circumstances) in Medicaid for children up to age 4. All Pennsylvania children in CHIP have continuous eligibility for a full year,” its authors wrote.

“It will be imperative for DHS to implement an unwinding process that does not disconnect the children most at risk of losing coverage, particularly when Pennsylvania’s uninsured rate is starting to improve,” King said.

Read the governors’ full letter:

Portions of this story were first published by the Iowa Capital Dispatch, a sibling site of the Pennsylvania Capital-Star. Jill Nolin, a reporter for the Georgia Recorder, a Capital-Star sibling site, contributed additional reporting.