The post-Covid increase in Medicaid enrollment with relaxed standards has come to a close as the world returns to normal. However, the Medicaid disenrollment process should be an orderly and strategic one. Efforts earlier in the year were aimed at state compliance. However, the Interim Final Rule promulgated by the federal government amped up the enforcement requirements against the states. This unwinding of continuous enrollment had already begun after the Covid public health emergency was officially, and legally, ended by the federal government. The Center for Medicaid and Medicare Services is enforcing standards on the disenrollment by states of Medicaid beneficiaries. Lack of current compliance as to reporting obligations and improper disenrollment procedures will lead to the penalization against the states.
Acting too strongly, and states will disenroll Medicaid recipients in violation of federal rules. Acting too leniently, and states will have swollen Medicaid rolls that they cannot afford to fund. Medicaid disenrollment, especially by “red states” disinclined to pay for large Medicaid populations, has been described as a wave hitting the health care sector.
The federal government via the Center for Medicaid and Medicare Services published an Interim Final Rule in the code of federal regulations governing this process. This federal administrative regulation took effect immediately, although there remains a notice and comment period thereafter that may shape the final law.
Millions of Medicaid beneficiaries were disenrolled in 2023 starting in April with the end of the COVID-19 pandemic. Some or many of those persons may obtain coverage elsewhere, but there remains an ongoing detriment to persons foregoing preventative care, not getting access to needed health care services, and thus an increase in emergency department visits and increased morbidity and mortality in general.
There are potential consequences to the states for non-compliance with current disenrollment standards. Procedural issues have resulted in the majority of disenrollments, such as failure to keep one’s address and employment information current, rather than substantive reasons for denials and disenrollments due to actual ineligibility.
The Interim Final Rule is designed to continue the federal and state collaboration on state efforts to comply with disenrollment mandates – before punitive and sanctioning action is taken by the federal government.
Learning Objectives: -
Who will Benefit?
Healthcare law attorneys; licensed healthcare practitioners in private practice who accept Medicaid; medical directors of health facilities; office managers and medical directors of private medical offices; healthcare managers and executives; corporate counsel in health care; health care administrators; university faculty in health care and medical health policy; allied health professionals in graduate-level medical education across the many health care professions; corporate compliance officers; human resource directors and departments; state Medicaid officials
Who Should Attend
Mark R. Brengelman became interested in law when he graduated with both Bachelor’s and Master’s degrees in Philosophy from Emory University in Atlanta. He earned a Juris Doctorate from the University of Kentucky College of Law. Mark became an Assistant Attorney General in Kentucky in the area of administrative and professional law as the assigned counsel and prosecuting attorney to numerous health professions licensure boards.He retired from the state government, became certified as a hearing officer, and opened his own law practice, including work as a legislative agent (lobbyist).As a frequent participant in continuing education, Mark has been a presenter for over fifty national and state organizations and private companies as the: Kentucky Bar Association Kentucky Office of the Attorney General National Attorneys General Training and Research Institute, and Federation of Associations of Regulatory Boards (FARB).This also includes FARB’s member clients as the: Association of State and Provincial Psychology Boards Federation of State Boards of Physical Therapy National Council of State Boards of Nursing National Association of State Emergency Medical Services Officials National Association of State Contractors Licensing Agencies, and; American Association of Veterinary State Boards.Mark was the founding presenter for “Navigating Ethics and Law for Mental Health Professionals,” approved by five Kentucky licensure boards. He also founded “The Kentucky Code of Ethical Conduct: Ethical Practice; Risk Management, and; the Code of Ethical Conduct” as an approved, state-mandated continuing education for social workers offered as a video-on-demand.Mark has now worked for all three branches of state government has worked since June 2018 as the Enforcement Counsel for the Kentucky Legislative Ethics Commission, an independent regulatory body that oversees 138 elected state legislators and nearly 800 registered lobbyists. Continuing as an ethics attorney, Mark is also the contract counsel for the Ethics Commission of the Louisville Metro Government, a city and county merged government, the largest city in Kentucky, and the 45th largest metropolitan statistical area in the United States.Mark focuses on representing health care practitioners before licensure boards and in other professional regulatory matters and representing children as Guardian ad Litem and parents as Court Appointed Counsel in confidential child dependency, neglect, and abuse proceedings and termination of parental rights and adoption proceedings in family court.
