WASHINGTON (Jan 19, 2023) — A new report from the Geiger Gibson / RCHN Community Health Foundation Research Collaborative examining the financial and patient care impact of unwinding Medicaid’s continuous enrollment policy finds that up to 2.5 million community health center (CHC) patients could lose their Medicaid coverage once continuous enrollment ceases. This could, in turn, trigger a loss of $1.5 billion to $2.5 billion in patient revenue, which amounts to between 4% and 7% of national total health center revenue. A revenue impact of this size means that CHCs, the nation’s largest primary care system for medically underserved rural and urban communities, will be able to serve between 1.2 million and 2.1 million fewer patients and employ 10.7 thousand to 18.5 thousand fewer staff. The study is based on estimates of the unwinding impact prepared by the Urban Institute as well as data on community health centers from the 2021 Uniform Data System data. The authors at the George Washington University Milken Institute School of Public Health report that these estimates likely are low, since they were based on 2021 health center data and the number of CHC patients likely increased over the 2022-2023 time period.
Continuous Medicaid enrollment was a centerpiece of the 2020 Families First Coronavirus Response Act, which has stabilized coverage for millions of beneficiaries who otherwise might have lost it during the worst public health emergency in a century. The Consolidated Appropriations Act, passed by Congress at the end of 2022, formally ends the policy on March 31, 2023. Although states are given 14 months to complete unwinding and reinstate the normal eligibility determination process, federal enhanced funding levels to complete redeterminations last only through the end of 2023, meaning that states will feel financial pressure to move rapidly.
“The end of continuous coverage will compromise patient care, disrupting continuity of service for many individuals and families, and substantially decreasing community health center Medicaid revenue, which will further erode capacity,” Feygele Jacobs, Professor and Director of the Geiger Gibson Program at GW Milken Institute School of Public Health, said. “It is essential that health centers receive the support they need to serve their patients as pandemic-era policies wind down.”
Leighton Ku, professor of health policy and management at GW, and his team conclude that while careful unwinding procedures to reduce the risk of erroneous terminations are essential, CHCs face an urgent need for increased grant funding to offset these losses, because community health centers derive 40 percent of their annual revenue from Medicaid. CHCs also need long-term stabilization of the Community Health Center Fund, which provides core-operating grants, if they are to maintain services at a critical time for millions of residents of medically underserved communities confronting the loss of Medicaid and facing deep poverty and elevated health risks.
“The continuous enrollment policy led to substantial increases in Medicaid enrollment during the public health emergency,” Ku, who is also the Director of the GW Center for Health Policy Research, said. “While it is difficult to project precisely, the end of continuous enrollment will clearly trigger not only losses in coverage, but also substantial decreases in the very revenue that health centers need to provide essential services."
The data note, “The Potential Effect of Medicaid Unwinding on Community Health Centers,” was authored by Ku and researchers at the Geiger Gibson / RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health.
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