The big economic experiments of the pandemic are winding down.
Direct government aid to businesses and individuals wrapped up in 2021 and last year. Extra benefits to food stamp recipients ended Tuesday. Also Tuesday, the Biden administration's drive to forgive student debt had its day at the Supreme Court, with an outcome likely this summer.
The next turning point is May 11, when the federal government will end the pandemic's classification as a public health emergency. That will not just change how COVID-19 is tested and treated. It will unravel an insurance safety net woven by Congress and the Trump administration in the early days of the pandemic.
They required states to keep people enrolled in Medicaid programs — which are designed for low-income Americans — until the emergency ends.
With the yearly process of re-enrolling for Medicaid benefits on hold, more people kept them and the system's "churn" stopped. As a result, total Medicaid enrollment rose 28% nationally, and 30% in Minnesota, over the last three years. The rate of uninsured Americans fell back to near the record low of 2016.
The state's insurers and health officials have been preparing for the day when 1.5 million Minnesotans on Medicaid programs — either Medical Assistance or MinnesotaCare — will have to once again re-enlist for their benefits. The moment is so important and the process so big that it spawned a new piece of jargon in health care:
The risk and fear is that people will fall through the cracks during the process of redetermining whether they should be getting government help for health care.
The Minnesota Department of Human Services (DHS) estimates 15% to 25% could lose eligibility — either because their finances have improved, which is fine, or because they didn't go through the process, which is not.
"This is a particularly big challenge for these individuals," said Hilary Marden-Resnik, chief executive of UCare, the Minneapolis insurer that serves more Minnesotans on government health plans than anyone else.
For insurers, it's also a challenge to retain members on Medicaid-related plans or, if they no longer qualify for them, to find an affordable replacement.
"If they learn that they're no longer eligible for Medicaid, that's OK. They can have continuous health coverage, probably with a subsidy," Marden-Resnik said. "Sadly, there will be some people who will lose Medicaid coverage simply because they don't follow through with the processes that are required."
Andrea Walsh, CEO of HealthPartners, the Bloomington company that runs both health plans and a hospital system, said the redetermination process will affect both businesses.
"We'll be communicating with our members when they show up in our clinics and hospitals, and supporting the state and counties in that eligibility determination," she said.
The logistics are daunting. To avoid a jam with 1.5 million people trying all at once to re-qualify, DHS is dividing the state's Medicaid recipients based on the month when they first became eligible. A bill introduced by Rep. Mohamud Noor in the Minnesota House this week would give the department more leeway to extend the time frame of eligibility decisions.
But it's a paper-based process that involves more than just sending a quick return notice to the state, the way car tab renewals work. To keep Medicaid benefits, people will have to share financial information.
DHS will begin sending out renewal forms in May, starting with people whose eligibility date is in July. Along with MNsure, the state's insurance exchange, it has a network of people, called navigators or assisters, to help Minnesotans with the process.
The department's enrollment materials are in six languages online. The insurance firms hired translators to work with customers on the process. Ucare said it awarded grants to clinics and other care providers to get the word out.
If people unknowingly lose coverage, health care providers may not be compensated for care received by former Medicaid enrollees, Marden-Resnik said, and that's something "we don't want to see … at a time when they're already experiencing significant financial challenges."
But even with all that preparation, it's likely that some people will be missed. They will lose health coverage and will wind up stressing clinics and hospitals. Among the people Medicaid helps are those living on the fringe, without work, permanent addresses and, sometimes, family. (Minnesotans who need to update their contact info can click here.)
For 1 of 4 Minnesotans, the return of churn in the Medicaid process will bring more complication to lives that are already stressful.
And a new experiment in the efficiency of health care will emerge. Insurers, care providers and health officials will learn what is more efficient: managing Medicaid programs to precise qualifications or taking the looser approach that happened over the last three years.