Hospitals & Facilities

Federally qualified health centers are playing a key role in Medicaid unwinding

FQHCs are working to ensure Medicaid recipients aren’t caught off guard as states determine coverage eligibility.
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Amelia Kinsinger

· 5 min read

For almost 60 years, federally qualified health centers (FQHCs) have played a key role in providing medically underserved populations and areas with affordable and quality care, regardless of a person’s ability to pay.

Now these nonprofit community health centers are on the front line as states work through a three-year backlog of Medicaid eligibility determinations—a process that was put on hold during the Covid-19 pandemic after the federal government offered states higher reimbursements in exchange for keeping recipients enrolled in Medicaid programs.

As many as 17 million people could lose Medicaid coverage due to ineligibility or other renewal barriers during the unwinding period, which began April 1, according to KFF estimates. At least 5.4 million people have lost Medicaid coverage as of August 23, according to data from 45 states and Washington, DC, KFF reported.

With FQHCs caring for an estimated one in six Medicaid recipients, community health centers across the US have beefed up their efforts to help patients through the transition and brace for any potential fallout. About 86.8 million people were enrolled in Medicaid nationwide as of the end of May, according to federal estimates.

The Texas Association of Community Health Centers (TACHC), which represents 73 FQHCs operating 650+ clinics in 137 counties, for example, urged its members to upgrade their community partner programs ahead of the unwinding period so the health centers could help Texas residents renew their Medicaid coverage or enroll in plans available via the federal health insurance marketplace.

Sonia Lara, TACHC’s outreach, enrollment, and special populations director, told Healthcare Brew that the association has also worked with members to develop ads in English and Spanish offering free help to Medicaid recipients who may lose coverage due to redeterminations. About a third of Texas FQHC patients are enrolled in Medicaid.

TACHC member centers are also working with some managed care organizations to reach out to FQHC Medicaid patients about the renewals—though not all insurance plans are doing that, Lara noted. Another challenge, she said, is that the state doesn’t share enrollment data with FQHCs.

“It’s all hands on deck. We all want to help our families—none of us want to see our families lose coverage,” she said. “Our health centers also are able to pull who has Medicaid on their side, but it’s kind of helpful when you’ve got the health plans that have the renewal dates, as well. They can tell us these are the people that we need to contact.”

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By the numbers

The number of Texas residents enrolled in Medicaid surged to about 6 million during the Covid public health emergency, up from 3.9 million enrollees, according to the state’s health and human services agency.

As of August, Texas has initiated renewals for 2.5 million residents—42% of the state’s Medicaid population. Officials have denied at least 616,500 renewal requests, which is more than two-thirds of the 926,000 processed as July 31. Of those processed requests, about 126,000 were deemed ineligible for Medicaid and approximately 491,000 resulted in procedural denials.

By August, TACHC-member FQHCs started to see some people come in with questions about their Medicaid eligibility, but it still wasn’t the volume they had expected, Lara said. TACHC members have assisted people with health coverage more than 50,000 times between January and August.

“A lot of people have not been used to renewing their benefits for three years. Now they’re telling them to come in, so they’re a little rusty,” she said. “We’ve been hearing from some of our health centers that they’re starting to see more people coming in, which is great because initially when it first ended, we were like, ‘OK, now it’s time folks,’ and we weren’t really seeing that foot traffic in our health centers.”

However, that could change: More people may go to the doctor and realize they have lost their Medicaid coverage, Lara said.

More than a quarter of community health centers nationwide (which include FQHCs) said they expected about 15% or more of their patients to lose coverage during the redetermination process—and more than half said they expected at least 10% of patients to lose Medicaid, according to a National Association of Community Health Centers survey released in March.

Over half of the 420 health centers surveyed further said they expect to reduce staffing and retention efforts and scale back services due to financial and operational strain.

Despite the expected demand for enrollment and renewal assistance as well as the increase in uninsured patients at FQHCs, TACHC members are financially prepared, thanks in part to ongoing funding the association has received since 2013, Lara said. FQHCs are also used to serving uninsured patients.

“It’s business as usual for us,” she said.

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Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.