The end of the national COVID emergency could change what we know about the virus’ activities in Alabama.

And it could also affect the state’s Medicaid rolls. The national public health emergency (PHE) required Medicaid agencies to keep people enrolled in the program, even if they no longer qualified for it. With the end of the PHE, a number of Alabama Medicaid recipients will lose coverage, though the exact number is not clear.

Nationwide, up to 15 million people could lose coverage in Medicaid or the Children’s Health Insurance Program (CHIP) when the PHE ends this spring. About 91.3 million Americans were enrolled in the programs last October, according to the Centers for Medicare and Medicaid Services.

More from Alabama Reflector

The Medicaid Continuous Enrollment Provision, part of the emergency provision, was effectively discontinued last December. States will begin taking people off Medicaid on April 1, ahead of the end of the PHE on May 11.

Experts worry that nearly 7 million people otherwise qualified for Medicaid will lose coverage for failing to complete renewal forms or not updating their addresses. Jennifer Tolbert, director of the State Health Reform program and associate director of the program on Medicaid & Uninsured at the Kaiser Family Foundation, said children in Alabama will not be affected. Children are provided continuous coverage for 12 months and cannot be kicked off the program during that period.

“In a state like Alabama, there are concerns that adults, parents, in particular low income parents, are at risk of losing coverage because the state has not expanded Medicaid,” Tolbert said. “So many parents who did qualify during the pandemic will lose coverage once the disenrollment resumes.”

Alabama Medicaid Agency Commissioner Stephanie Azar said during a partner and provider meeting on Feb. 7 that during the emergency, people were only removed from Medicaid if they died, moved out of state or asked to be taken off.

Azar also said that Medicaid recipients also had access to telemedicine visits; no copay for provider visits or prescriptions, and no referral requirements. Some of these allowances will end post-PHE once the agency makes those determinations.

To ensure qualified recipients continue receiving Medicaid, the agency plans three phases of messaging. The first will be “get ready,” telling those in Medicaid to renew their membership; stay up-to-date about changes that can affect their benefits and update their mailing address and other personal information as soon as possible. The information is available in English and Spanish and will be provided in other languages if requested.

The agency will also encourage Medicaid recipients to check their mail for a letter they must return to the Medicaid Agency. The third message will remind people to renew their coverage when the time comes.

With this phased approach, the Alabama Medicaid Agency hopes to keep eligible Medicaid recipients enrolled.

Before disenrollment, the state must try to contact Medicaid recipients. If a renewal notice that is returned undeliverable, the Medicaid Agency must make at least two attempts to contact the recipients, such as via texting or email.

Changes to reporting

The end of the PHE will also mean changes to COVID-19 policies and, in some cases, flexibilities offered in the emergency declarations.

Public health departments will lose many of the tools they were given during the PHE to combat the pandemic. The U.S. Department of Health and Human Services will no longer be able to require COVID-19 lab results and vaccine data from labs.

That may affect the reporting of negative test results and the ability to calculate positivity percentages for COVID-19 tests. It is unclear whether the state will continue to require this data to be reported past the end of the PHE.

The PHE required reporting of COVID-19 illnesses. Prior to the emergency, respiratory illness were generally not reported to the CDC. Dr. Wes Stubblefield, the Alabama Department of Public Health’s district health officer, said flu deaths are reported, but not cases of flu or RSV. The CDC does collect data on “flu-like illnesses,” and although not all those cases are flu, it generally tracks along with flu infections.

“It means that the amount of data on the SARS-COVID-2 to laboratory results will change,” Stubblefield said. “And it may impact both the speed of reporting and the percent positivity of the tests, which goes into how they communicate the transmission levels.”