Challenges for States as Public Health Emergency Ends


There are no easy solutions for people who gained insurance coverage through Medicaid.

The Public Health Emergency that was declared at the beginning of the pandemic and extended eight times since is expected to be lifted sometime this year. When it ends, numerous federal policies that have far-reaching effects across the health system end with it.

A report from the Robert Woods Johnson Foundation looked at the implications of the end of the PHE.1

All states will need to reassess Medicaid eligibility resulting in a projected 13 to 16 million people losing their coverage. Up to one-third of those may be eligible for subsidized marketplace health plan, but getting them moved to the new program presents massive challenges to Medicaid officials because of the sheer volume of people. Planning is difficult, because there is uncertainty as to when the PHE will end. Officials will need to determine eligibility requirements and direct people to the appropriate program.

Fifteen million or more current Medicaid enrollees will potentially be ineligible for Medicaid at the end of the PHE, so states face a monumental task catching up on delayed renewals and redeterminations, according to the report. A lack of funding is expected to hamper this effort in many states, and those that have funding don’t want to hire staff until there is work to be done, but no one knows when that will start. Staff training is needed beforehand, but with no known start date for the end of PHE, timing is difficult for Medicaid officials.

Another challenge for state officials, according to the report, is to reduce the number of people who fall through the cracks and become uninsured. People will need targeted messaging to direct them to the right plan and program, and states aren’t always successful with their messaging. When confronted with an overwhelming volume of complicated plan choices, many consumers make no decision at all.

State officials indicated that there are just too many unknowns to make a smooth transition possible. There is uncertainty over federal requirements and standards for how eligibility will be determined, which combined with the uncertainty over timing, creates unique challenges.

The report reads in part: “In most of our study states, legislators have taken little to no action related to the end of the PHE and the potential termination of Medicaid coverage for thousands (and in some cases millions) of their constituents. No Medicaid official reported any pressure from legislators to speed up redeterminations for fiscal reasons.

Another concern is that Marketplace plans have narrow provider networks that may be inadequate to meet the needs of the large influx of new enrollees. If a large share of people in a given service area gravitate to just one or two narrow-network plans in a short period of time, they may face delays or difficulties accessing timely appointments for needed services, according to the report.

In addition, Medicare agencies are all are facing the same labor shortages as private sector employers, and few expected significant increases in funding from the state to support hiring additional staff or augmenting their Navigator grants.

This article originally appeared on Medical Economics.


  1. Corlette S, Bluberg LJ, Houston M, Wengle E. Preparing for the biggest coverage event since the Affordable Care Act. Robert Wood Johnson Foundation. March 1, 2022. Accessed March 31, 2022.
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