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Citing Medicaid misery, 25 governors push for PHE's end in April

Molly Gamble

December 21, 2022

In a letter sent to President Joe Biden this week, 25 governors ask for the end of the COVID-19 public health emergency in April.

HHS last renewed the federal PHE in October for another increment of 90 days — until January 11 — with the pledge to provide states with 60 days' notice if it decided to terminate the declaration or allow it to expire. Since those 60 days came and went without notice, states are operating under the assumption the PHE will be renewed for another 90 days and expire in April, unless extended again.

"We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration," the governors urged Mr. Biden in their Dec. 19 letter.

The governors claim the PHE hurts states, largely through the Medicaid flexibilities costing states "hundreds of millions of dollars." Under the continuous coverage requirement of the Families First Coronavirus Response Act, state Medicaid agencies are barred from disenrolling people during the PHE — unless they request it — in exchange for an enhanced federal match. HHS estimates up to 15 million people will be disenrolled from Medicaid and the Children's Health Insurance Program when the PHE ends.

"While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," the governors wrote to Mr. Biden. "Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share."

The governors sent their letter a day before Congress released its omnibus spending bill, which contains working language for states to be able to start evaluating Medicaid enrollees' eligibility as of April 1 in a redetermination process that would take place over at least 12 months. The measure also calls for phasing down the enhanced federal Medicaid funding through December 31, 2023, though states would have to meet certain conditions during that period.

The American Hospital Association advocated for the latest extension of the PHE in October, noting that the majority of the hospital members it polled said they still depend on the flexibilities provided by the PHE waivers to deliver care.

The letter was initiated by Chris Sununu, governor of New Hampshire, and signed by the following:

Kay Ivey, Alabama
Mike Dunleavy, Alaska
Asa Hutchinson, Arkansas
Doug Ducey, Arizona
Ron DeSantis, Florida
Brian Kemp, Georgia
Brad Little, Idaho
Eric Holcomb, Indiana
Kim Reynolds, Iowa
Charlie Baker, Massachusetts
Tate Reeves, Mississippi
Mike Parson, Missouri
Greg Gianforte, Montana
Pete Ricketts, Nebraska
Doug Burgum, North Dakota
Mike DeWine, Ohio
Kevin Stitt, Oklahoma
Henry McMaster, South Carolina
Kristi Noem, South Dakota
Bill Lee, Tennessee
Greg Abbott, Texas
Spencer Cox, Utah
Glenn Youngkin, Virginia
Mark Gordon, Wyoming

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