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Health officials around the country added flexibility to Medicaid rules in 2020 to make it easier for patients to continue accessing care in the midst of a pandemic. 

Much of that ends Thursday, when the national COVID-19 emergency declaration expires.

Up to 400,000 Virginians risk losing Medicaid as the state starts a process called “unwinding,” purging names from its rolls to re-evaluate their eligibility. 

They’re among the 5-14 million people that the Kaiser Family Foundation estimates could lose coverage nationwide.

Virginia expanded Medicaid in early 2019, which grew enrollment in the ensuing years by 46%, to about 2.2 million people.

Medicaid usually requires members to submit a renewal each year to ensure their eligibility, based on factors including income and citizenship.

The Families First Coronavirus Response Act of 2020 put a pause on those annual reviews, allowing for continuous coverage under Medicaid and the Children’s Health Insurance Program. 

“Medicaid is an essential tool in the Commonwealth’s response to COVID-19,” Karen Kimsey, director of the state Department of Medical Assistance Services, said in a statement that April.

“Thousands of individuals are experiencing the loss of employment and insurance, and we want them to know that we are here to help them access health care during this critical time.”

This week marks the return to annual re-enrollment.

Health care advocates say they’re concerned by the potential for “churn” — a temporary loss of coverage when Medicaid patients have to re-enroll.

The Kaiser Family Foundation says it happens when enrollees have short-term changes in income or other factors that make them temporarily ineligible, or simply face challenges during the renewal process.

People who have disabilities, language barriers or have recently moved are at increased risk, in addition to people of color and children, according to the foundation. 

The change impacts different corners of Virginia’s medical system — such as doula care, which is only covered by Medicaid.

Other flexibilities will also go away, some this week and others in November.

Moms in Motion helps Virginia families navigate and use the Medicaid waiver system for people with disabilities.

CEO Joy Spencer said during the pandemic, parents or spouses were able to use Medicaid money to care for disabled loved ones directly, instead of hiring someone through an agency.

Advocates successfully lobbied the General Assembly to enshrine those flexibilities in state law. But new federal guidance from the agency that oversees Medicaid overpowers much of that.

Family caregivers would have to go through an agency and receive more than a week of training first.

“People are not real thrilled about it, as you can imagine,” Spencer said. “I wouldn’t need 40 hours of training to care for my own son, for example.”

Moms in Motion is working to get the word out about that and other impending changes, including the end of continuous enrollment. 

Many people may not realize they need to re-apply until they lose coverage, Spencer said — especially because so many of them only got on the rolls right before the pandemic, when Virginia expanded Medicaid.

“For three years now, people have been getting these services and gotten very used to having them,” she said. 

“It’s a hard system to navigate. … The only constant in our industry is change. It is forever changing, and it’s hard to keep up with.”

She encourages people who are denied Medicaid coverage to appeal the decision.

Some flexibilities will remain permanently in Virginia, such as certain telehealth services and expanded opioid treatment methods.

Other federal COVID-era policies also expire this week, including free coronavirus tests and increased funding for public assistance programs.

You can learn more about the unwinding and how to ensure Medicaid coverage on the Cover Virginia website.