The Centers for Medicare & Medicaid Services (CMS) took significant actions this week to help people who have been inappropriately removed from the Medicaid rolls after the official end of the pandemic’s public health emergency. 

Unfortunately, the initiatives have done little for those older adults at home and many with disabilities who use Medicaid home- and community-based services (HCBS), according to Damon Terzaghi, director of Medicaid HCBS for the National Association for Home Care & Hospice.

“We believe that the Medicaid eligibility regulations released this week, coupled with today’s announcement, will increase access to important services that participants rely upon,” he told McKnight’s Home Care Daily Pulse in an email sent Thursday. “We also know that there continue to be challenges with renewals for people who rely on Medicaid home care services. We ask CMS to encourage and, where allowable, require states to share more information with the home care provider community so that they can assist their clients with timely renewals and avoid lapses in coverage.”

Among CMS’ actions of late, on Wednesday it finalized a rule that eases eligibility requirements and reduces sign-up challenges. Then on Thursday CMS extended a temporary special enrollment period (SEP) to allow many disenrolled Medicaid recipients to access the Health Insurance Marketplace in states using Unfortunately, Terzagi clarified, people on Medicare cannot access the exchange. Also, Medicaid benefits for those in long-term care are essentially impossible to replace.

“Due to the more extensive supports available through Medicaid, people who are disenrolled do not have any other way to access the important premium and cost-sharing assistance and long-term care benefits that Medicaid offers,” Terzaghi explained.

There is no question that older adults and people with disabilities have been hit hard by the unwinding. By Terzagi’s estimates — and he has been keeping track of each state’s disenrollments to the extent the data is available — around 1.9 million older adults and people with disabilities have been disenrolled.

That likely is an underestimate.

“As I’ve said before, I think that the numbers undercount the reality due to the lack of specificity around these groups,” Terzaghi wrote. “I remain concerned about these individuals falling through the cracks and losing access to needed services that aren’t available via the exchange and Medicare.”

Terzaghi encourages CMS to do the following:

1. Require states to track and publicly report disenrollments based on eligibility categories, including non-MAGI [non-Modified Adjusted Gross Income] (i.e., ABD) [Aged, Blind or Disabled] populations; and

2. Require states to give providers, including home care agencies, information on the upcoming renewals for the individuals they serve to make sure they can help them with the process.

In light of all this, I think it’s fair to say that CMS’ work on Medicaid disenrollments is far from over.

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].