Payer Update, January 2023

Payer Update

Prepare for the Medicaid PHE Unwinding and Redetermination Process
by Jeff Amond, Director Member & Community Relations
and George Oestreich, Government Payer Consultant

As part of the COVID-19 public health emergency (PHE), state Medicaid programs were not allowed to conduct the typical annual re-determination process for beneficiaries (i.e., state Medicaid programs could not remove anyone from their rolls). The Consolidated Appropriations Act, 2023, enacted in December 2022, included a policy ending this continuous enrollment condition on a set date – March 31, 2023 (this process is also known as the “unwinding”).

States can begin their first Medicaid redeterminations as early as February 1, 2023 (with terminations beginning April 1, 2023). States have a year to start renewals for all people and must be complete by May 31, 2024. This process will have a huge impact: the Department of Health and Human Services (HHS) has estimated that as many as 15 million people will be disenrolled, including 6.8 million who will likely still be eligible.

What does this mean for HTCs? It means every single one of your patients who is enrolled in Medicaid will have to go through a process to redetermine their eligibility. To assist with your preparation for this process, we have provided a few suggestions to help make this a smoother transition for you and your patients:

  1. Do a deeper dive into your current patient population. Identify each of your current patients that are on Medicaid and proactively contact them about the Medicaid recertification changes. Encourage them to update their contact information with the state Medicaid program and to open and respond to any mail they receive. Try to identify families that may need additional assistance navigating the process.
  2. Research what your state’s timeline and process will be. You can check websites like: and the Georgetown Center for Children and Families has a great state tracking document that they are continually updating here. You can also proactively reach out to your state Medicaid office regarding their process/timeline for restarting eligibility recertifications.
  3. Provide education to patients about other options, in case they are no longer eligible for Medicaid. For example, assist patients in completing an application for a plan offered on the ACA marketplaces.
  4. **Your work could not be more important as we approach this critical time**

As we get past the February 1st start date for this process, more and more information will be available. The Alliance team and other bleeding disorders organizations, including NHF and HFA, will release more tips, tricks and resources over the coming weeks and months. Please remember that the Hemophilia Alliance and our consultants are here to assist. Reach out to George Oestreich, PharmD, MPA ( or any of your HA contacts for additional information or assistance. WE WORK FOR YOU!

Also in this Issue…

Notes from Joe
· Isn’t it Strange?

Alliance Update
· Reminder: The 340B Program Recertification Period is Open!
· Save the Date for Alliance Meetings for 2023!

Legal Update
· 340B Compliance Spotlight: The Importance of Self-Audits

Washington Update
· 2023 Washington Outlook

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