Adapting ACA Access Amid Medicaid Transition and Policy Reversals: Molly Dean

During the COVID-19 pandemic, Congress temporarily suspended eligibility checks for Medicaid and the Children’s Health Insurance Program (CHIP), ensuring uninterrupted access to health care for millions of Americans.1 As a result, Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.”

To mitigate disruptions in care, some states offered financial assistance to help those transitioning from Medicaid to Affordable Care Act (ACA) marketplace coverage. As of October 2024, Medicaid enrollment had declined by 14.7 million, including over 5.5 million pediatric patients.2 This shift also affected community health centers, which serve 1 in 9 pediatric patients and help systemically marginalized patients overcome barriers to care.

Amidst the ongoing transitions of Medicaid unwinding is the new presidential administration of Donald J. Trump, which brought changes to health policy.3 While the administration was ordered to reverse course on a move that raised alarms for jeopardizing coverage for nearly 80 million Americans enrolled in Medicaid and rescinded the directive that had ordered federal agencies to freeze trillions in financial assistance, enrollees still face barriers in accessing the platform and uncertainty surrounding the future of health assistance.3,4

Molly Dean, MSW, policy advisor at Siftwell, joined The American Journal of Care® (AJMC®) to draw attention to potential challenges that may arise and highlight areas that health centers and public entities can focus on to best support individuals during these shifts.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Given recent changes in ACA enrollment and the new presidential administration, what are the biggest policy challenges ahead for Medicare and Medicaid programs?

I think the reality of current state really is going to force states and programs to look at how they maintain providing care and coverage, frankly, to Americans and to the members that they currently provide coverage to. I think at the suspension of the public health emergency, you saw a tremendous amount of Americans coming off Medicaid rolls. Some needed to, right? They were no longer eligible. Some, unfortunately, due to administrative issues, if you will, or who were unable to reach them and contact them, came off the rolls and have lost coverage.

We really need to ensure that public entities that support individuals can maintain access to care whether they maintain Medicaid coverage or not. And so I think it's understanding who is providing care to underinsured and uninsured people in communities, and ensuring that those entities have funds to be stable. Traditionally, that is through Medicaid. I think about your federally qualified health centers, the pivotal role they play in covering and, more importantly, providing care to individuals. A lot of those entities are funded through braided funding streams, much of which is Medicaid funds. And when there is a threat—or kind of a restriction, both of coverage and those funds—you land in a place where your safety net is going away. So I think that is going to be a critical, critical opportunity that has to be seized here quickly to ensure the safety net is stable.

What that's going to do is require a shift. There has been a tremendous amount of focus over the last 4 years on workforce and developing workforce and developing pipeline to ensure that there are enough people to care for the demand, but I think we're going to see an immediate shift towards just shoring up these entities to ensure they can pay their bills. And I think that's one of the biggest quick impacts we're going to see with the loss of coverage. Loss of coverage because of people losing coverage on the other side of the public health emergency. And then, with the potential kind of restructuring of Medicaid, we're seeing waving in the wind right now with a new administration, that's going to be critical.

References

1. Grossi G. Lessons learned from Medicaid unwinding as states tackle eligibility checks. AJMC. November 7, 2024. Accessed February 19, 2025. https://www.ajmc.com/view/lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks

2. McCormick B. Medicaid unwinding left thousands of pediatric patients uninsured. AJMC. February 7, 2025. Accessed February 19, 2025. https://www.ajmc.com/view/medicaid-unwinding-left-thousands-of-pediatric-patients-uninsured

3. Klein H. Trump's federal grant freeze threatens Medicaid funding. AJMC. January 28, 2025. Accessed February 19, 2025. https://www.ajmc.com/view/trump-s-federal-grant-freeze-threatens-medicaid-funding

4. Grossi G. RFK fails to offer a clear Medicaid, Medicare strategy. AJMC. January 29, 2025. Accessed February 19, 2025. https://www.ajmc.com/view/rfk-jr-fails-to-offer-a-clear-medicaid-medicare-strategy