Unwinding the Public Health Emergency (PHE) for LEAs

On October 13, the US Government extended the current Public Health Emergency (PHE) another 90 days.  This pushes the current federal expiration date to January 2023. During the past few State Workgroup meetings, DHCS shared information about unwinding the PHE and what that means for Medi-Cal beneficiaries.  There are currently two main effects ending the PHE will have on LEA’s and billing for school-based services. 

  • Continuous coverage will end for many Medi-Cal beneficiaries
  • The Federal Medical Assistance Percentage (FMAP) will go back to 50%

Let’s dive deeper into these two items.  As of March 1st, 2020, all Medi-Cal beneficiaries were given continuous coverage status through the end of the PHE.  This means that their Medi-Cal benefits were automatically renewed, and families did not need to qualify as normal.  Once the PHE ends, these Medi-Cal beneficiaries may have their benefits automatically terminated.  For these families to continue their benefits, they will need to either re-enroll or provide information to update their qualification status. Based on CMS policy, California has elected to end the PHE in February of 2023. 

Next, as an incentive and condition to provide continuous coverage, states were given a 6.2% increase in the FMAP. California’s normal FMAP is 50%, which means that Medicaid fee-for-service programs (like LEA BOP and SMAA) are eligible for 50% of the published rate for a direct and administrative service provided to a beneficiary.  As of March 1st, 2020, California’s FMAP was increased to 56.2%.  This means LEAs were reimbursed an additional 6.2% for eligible services. 

Over the course of the year following the end of the PHE, two actions will occur. The FMAP rate will return to 50%, reducing the amount LEAs receive for each eligible direct service.  Tying this with millions of potential beneficiaries losing Medi-Cal coverage, this may have a significant impact on LEA Billing Programs. 

But there is a plan.  CMS has developed an outreach campaign to assist Medicaid and CHIP beneficiaries in renewing.  This campaign is designed to reduce the gaps in coverage and ensure families and children receive needed care.  DHCS has also developed a plan in tandem with CMS and the success of this outreach campaign will hinge on communication. 

So how can LEA’s assist?  Begin providing outreach assistance now to students and families.  You do not need to know anything about a family’s insurance or financial situation to provide eligible outreach assistance.  The sooner families renew their benefits or update their information to qualify, the less chance there will be that they will have a gap in coverage. 

How is Practi-Cal assisting LEA’s?  Practi-Cal recognizes the effect of ending the PHE will have on students receiving health care services and how that affects education.  We also recognize the financial impact this will have on school-based billing programs.  For these reasons, we have registered to be DHCS Coverage Ambassadors, to assist with promoting outreach and raising awareness of the benefits of Medi-Cal coverage in education.   

Practi-Cal has also developed an electronic method for LEA’s to easily facilitate outreach campaigns directly from our software.  While this option is ready for our clients, it is currently on hold, as DHCS must first revise the Data Use Agreement (DUA), to include outreach, as an acceptable use of benefits information data. Practi-Cal focuses on being program compliant, and once the new DUA is submitted by LEA’s, you will be able to not only view beneficiary eligibility data (currently allowable and available), but further use this data to drive outreach campaigns at the click of a button.  Practi-Cal will provide materials and verbiage to make running your campaigns quick and easy.  You can target families with expired benefits or reach all families within your LEA.  Practi-Cal is also adding insurance application information to our Parent Portal, to assist with connecting families to Medi-Cal.

DHCS is still working on the new DUA, but we encourage you to reach out to DHCS to encourage them to approve and release the new DUA timely, as states are already working on outreach campaigns in preparation.  LEAs can reach program leadership at DHCS by emailing LEA@dhcs.ca.gov.  Ask DHCS to please approve and release the new DUA as quickly as possible, so that you may assist with both state and national efforts.  If you do reach out to DHCS, we would love to know.  Please drop us a line at lea@practi-cal.com.

If you would like more information about the unwinding of the PHE, our campaign features, or electronic outreach materials, you can reach us at: lea@practi-cal.com. To learn more about Practi-Cal, visit our website at www.practi-cal.com.