147: The Looming Medicaid Purge

Caroline Brazeel, ASTHO’s Senior Director for Population Health and Innovation, explains how states and territories are preparing for the moment when millions of children could lose health care coverage as early as this summer; two professionals...

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Caroline Brazeel, ASTHO’s Senior Director for Population Health and Innovation, explains how states and territories are preparing for the moment when millions of children could lose health care coverage as early as this summer; two professionals enrolled in a unique public health leadership program answer questions about their experience in a new ASTHO blog article; ASTHO President Dr. Nirav Shah wins an award from the American Medical Association; and ASTHO highlights Delaware and Kansas for work to address environmental public health challenges.

ASTHO Blog Article: Diversity in Public Health Leadership Has Never Been More Important

YouTube: AMA Awards for Government Service - Outstanding Career Public Servant at the State Level

ASTHO Blog Article: Implementing an Environmental Public Health Tracking Program – Challenges and Solutions

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This is Public Health Review Morning Edition for Thursday, March 31st, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.


Public health officials are bracing for the great Medicaid purge, the moment when millions of children could lose healthcare coverage if the pandemic's public health emergency declaration expires.

Caroline Brazeel is ASTHO's senior director for population health and innovation. She tells us how officials are preparing for a crisis that could happen as soon as this summer. It's our morning conversation.

What are public health officials doing about it to get ready or to address the problem if and when it happens?


Yeah, so, it's a complicated position for public health officials to be in for a couple of reasons. So typically in most states, the Medicaid program is managed by a state Medicaid director, and the public health official and the Medicaid director are like partners, right? There's a limitation sometimes in what a public health official has direct control over, and this gets into the way we talk about public health and that chief health strategist role.

So, a lot of what public health leaders can do and are doing is to become aware of the implications of the public health emergency ending and where they need to work with their counterparts to highlight potential risk and potential unintended consequences like this one here of policy changes that are going to go into effect when the public health emergency ends. So, part of it is understanding and mapping the ending of the public health emergency and communicating with your counterparts to highlight areas of risk.

And then, sometimes it can look like tapping into existing programs within public health. An example here where we've got kids that are at risk of losing their coverage—I mean, public health includes programs like Title V, Title X, family planning, maternal and child health, home visiting services, WIC. The program directors within public health that oversee those other federal funding streams that also serve these children, they are also good advocates to work collaboratively with their Medicaid counterparts at the state to basically ask what can we do to help you, and how do we make sure that parents realize that this new eligibility determination requirement is going to come back into effect and make sure that we keep as many kids covered as possible.


Is it your sense that ASTHO members are on this case, they're aware of it, getting ready for it?


They are very aware of the public health emergency and the implications of what happens when the PAG ends. ASTHO recently developed essentially a roadmap of these, or all of the policies and funding streams that were enacted over the course of the emergency to ensure people were supported and accessing care throughout the pandemic, and what the risk is of some of those policies terminating at the end of the emergency. It's a lot to map, frankly.

So, what we've done is to try to map that for state health officials. We shared that recently this week with them via our leadership team, and it's a living document that we're going to continue to keep updated and prepared for them so that they've got something to go off of. And honestly it looks a little bit different in every state.

But for this particular issue, it has been in the news quite frequently. Georgetown published an excellent paper. The Georgetown Health Policy Institute did that outlined the details of this projected loss in coverage and how it is potentially going to negatively affect millions of children across the country.

And so, there's a combination of public health leaders and then their program directors, I think, getting up to speed on what their own Medicaid program eligibility requirements are looking like and how they need to work closely with them just because of some of the procedural elements of having to, for example, respond to a letter that gets mailed to your house. Well, if a family moved during the course of the pandemic and they didn't keep their residence updated with the Medicaid program, that letter is going to go to the wrong house, the parents may not see it, and then the kid could potentially be removed from the Medicaid roles erroneously. And the parents might not know until they show up at the doctor's office—or the emergency room, God forbid—needing services.


What should public health officials be doing right now if they're just tracking it? Is that it, or should they be making other plans?


There is definitely a planning element. So, the importance of tracking is that the public health emergency and what was authorized under it is very complex, right? So, this particular issue we're talking about here, the Medicaid purge in and of itself, is a very complex issue. And so, tracking helps you be aware of sort of where are the changes coming and what do I need to plan for. And then the plan itself is really dependent on which aspect of public health is this particular change going to affect.

So, the first thing for public health officials to do is to sort of tap into that document that ASTHO created that maps the effect of the end of the public health emergency. The next step is then to identify their team and how the particular change affects their team and determine what are the steps that they need to take to plan for those changes, and ASTHO is here to help them with that. We've got teams across the organization that can help them prepare plans and strategies. And then, if we need to advocate with the administration for any additional support, we can also do that through our government relations team.



Two professionals enrolled in a unique public health leadership program answer questions about their experience in a new ASTHO blog article. Luci Longoria with the Oregon Public Health Authority and Lieutenant Commander Traci Murray with the Substance Abuse and Mental Health Services Administration explain why they're part of the first class of recruits to the Diverse Executives Leading in Public Health program. It's hosted by ASTHO and the Satcher Health Leadership Institute with funding from the CDC.

Read the article using the link in the show notes.


Also, the American Medical Association announced it has given ASTHO president Dr. Nirav Shah its 2022 award for outstanding government service in the category of career public servant at the state level. Dr. Shah, director of the Maine Center for Disease Control and Prevention, accepted the award with a video message.


The COVID-19 pandemic has presented one of the most challenging periods any public health official could ever imagine. Evolving public health guidance must be delivered daily to populations that are equal parts frightened, exhausted, and buffeted with misinformation. The fact is that nothing prepares you for a job like this at a time like this, other than—well, having a job like this at a time like this; but it's a job that state health officials around the country do every single day.


You can watch the video on YouTube using the link in the show notes.


Finally today, learn how Delaware and Kansas solved environmental health challenges by collecting, tracking, and sharing data. The story is in a new ASTHO blog article online now. You can read about the approaches developed as part of the CDC National Environmental Public Health Tracking Program and how they were shared with others through ASTHO's related fellowship project.

Check out the link in the show notes.


Before we go, we want to remind you to leave us a rating and a review—they help raise our profile, and that makes it easier for new listeners to find us online. Also, if you follow the show, you'll never miss a single report. You can do all of this on the channel you're listening to right now.


That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Caroline Brazeel MPH

Senior Director, Population Health and Innovation, ASTHO

Nirav Shah MD JD

Director of the Maine Center for Disease Control and Prevention; President of ASTHO