with Alexandra Ellerbeck

Millions more Americans have been pushed into Medicaid during the coronavirus pandemic — 6.1 million by the latest count, and probably more. 

States will eventually need to weed out those who have become ineligible for the program perhaps through getting a job or a raise. They're banned from doing that right now, under rules tied to extra federal funds they've been getting to help cover the additional enrollees. 

There are competing concerns: Moving too hastily could result people being unduly stripped of health coverage. But letting the ineligible linger on the rolls would further weigh down already-strained state budgets.

“It has the makings of really a disastrous process,” said Eliot Fishman, a health policy expert at Families USA who was part of President Biden’s transition team. 

States are temporarily getting 6.2 percent more federal money to help pay for Medicaid.

Those funds were included in one of the coronavirus relief bills passed last March. Between Feb 2020 and September 2020, 6.1 million people joined Medicaid or the Children's Health Insurance Program, according to the Centers for Medicare and Medicaid Services.

But the money came with some requirements. States must also cover coronavirus testing and treatment without charging cost-sharing, and are mostly banned from kicking anyone out of Medicaid. 

That means some share of current Medicaid enrollees won’t actually qualify for the program by the time states are allowed to start checking eligibility again. It will be up to states to figure out who these folks are and remove them from Medicaid. 

The extra federal funds — and the ban — will end once Biden ends the declaration of public health emergency. It’s currently set to expire March 31, but Biden has signaled he intends to extend the declaration through the rest of 2021. 

At that point — whenever it comes — states will need to restart the eligibility verifications they normally conduct throughout the year. Because of the current ban on verifying eligibility, states face a huge backlog and could be under immense pressure to rush the verification process, which involves collecting documentation from enrollees.

And that could lead to people who are eligible getting kicked out if, for example, if someone has moved or their contact information has changed. 

Yet Medicaid directors also worry about the optics of letting people who are ineligible stay in the program.

“The longer you take and the more time and the more care you take to do that process effectively, humanely, appropriately, the longer those people are going to be on the rolls,” said Matt Salo, executive director of the National Association of Medicaid Directors.

Plus, keeping more people in Medicaid costs more money for states, who are grappling with budget cuts amid the economic recession. State health officials all over the country are projecting higher Medicaid costs for 2022.

Medicaid directors in about half the states have said the increased federal dollars were virtually zeroed out by extra demands on state funds to cover the new enrollees, according to Salo.

The Biden administration may give states more time to verify eligibility.

States and Medicaid advocates are asking the new administration for fresh guidance on carrying out the verifications. The Trump administration issued guidance last month indicating states would be given six months to verify eligibility, but some say that should be lengthened to 12 months.

“We particularly want to see states have time because this needs to be done carefully if we’re going to avoid large-scale coverage losses of people who are eligible,” said Judy Solomon, a senior fellow for health care at the Center on Budget and Policy Priorities.

Enrollment in the Medicaid program has reached peak levels during the pandemic. According to the latest report issued in September, 77.3 million Americans now rely on the federal-state program for health coverage.

Fishman said he expects some guidance from the Biden administration on Medicaid verification. But that’s not likely to come until the new administration has in place an administrator for the Centers for Medicare and Medicaid Services — and Biden hasn’t yet appointed anyone to that role.

Ahh, oof and ouch

AHH: AstraZeneca's vaccine drastically reduces transmission of the virus.

Researchers at Oxford University released new results from their vaccine, which is being manufactured by British-Swedish firm AstraZeneca, showing it gives 76 percent protection for three months after just one dose, Paul Schemm and Erin Cunningham report. “Testing also reveals that those vaccinated are much less likely to transmit the disease, which will help stem the continuing spread of the virus,” they write.

OOF: A worrisome coronavirus mutation has appeared in some infections caused by the U.K. variant.

“A coronavirus mutation that appears to limit the protection of vaccines against infection has appeared in the United Kingdom, which is already struggling with a highly transmissible and apparently more lethal virus variant,” Joel Achenbach and William Booth report.

Infectious-disease experts have nicknamed the mutation “Eeek” in reference to the fact that it occurs at a site on the virus RNA known as E484K.

The mutation is not entirely new. It’s come up many times since the start of the pandemic and was long seen as a potential problem, but it appeared to do little in isolation. Now, however, it is spreading in tandem with other mutations, including rapidly spreading variants in South Africa and Brazil, as well as appearing in some infections caused by a new, more transmissible variant in the United Kingdom. A public database shows 213 genomic sequences containing the mutation in the United States since March.

“The mutation alters the structure of the virus’s spike protein — the target for vaccines and many naturally produced antibodies. The mutation may help the virus to elude detection and make neutralization by the human immune system less efficient. In effect, it makes the virus stealthier, a great concern to vaccine developers, who seek to train antibodies to zero in on recognizable invaders and destroy them,” Joel and William write.

OUCH: New York Gov. Andrew Cuomo has announced that New York restaurants could reopen indoor dining by Valentine’s Day.

But the announcement has “left close observers of the city’s coronavirus data scratching their heads,” the New York Times’s John Keefe reports. As the governor announced the plan on Friday, “average per-capita case counts in New York City were 64 percent higher than when he announced an indefinite ban on indoor dining in December.”

Average hospitalizations were 60 percent higher than when Cuomo closed restaurants, although they are trending downward. State officials say that it’s this downward trend that justifies reopening restaurants, as well as the fact that New Yorkers appear to be infecting one another at a lower rate than in December.

The governor’s plan to reopen indoor dining on Valentine’s Day, a typically busy day for the restaurant industry, would allow a 25 percent capacity limit along with other restrictions.

The decision comes as Cuomo has faced criticism for ignoring the advice of top public health experts. At least nine top public health officials in the state have quit since the start of the pandemic.

More in coronavirus

Public health officials in the U.S. have little appetite for drastic actions to limit the spread of new coronavirus variants.

“As America faces the potential for catastrophic coronavirus spikes fueled by highly infectious variants, public health authorities remain wary of imposing the stricter measures adopted by other nations. Instead, they continue to embrace a stick-to-the-basics strategy: Wear a mask, maybe even two. Avoid crowds. And get vaccinated — fast,” Fenit Nirappil and Brittany Shammas report.

“The restrained approach differs from strict preemptive measures taking place in Europe, including lockdowns, classroom closures and requirements to wear medical-grade masks,” they write.

“The public doesn’t tolerate lockdowns very well anymore,” Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials, told The Washington Post. “You may have states that are aggressive sooner, but on the whole, a lot of them are not going to take those kinds of steps until it’s clear they have to.”

Public health experts stress that mask-wearing and social distancing will continue to be effective against the new variants, but some have also called for targeted restrictions in places where the variants are spreading. However, the U.S. is conducting little genetic sequencing on virus samples, meaning that public health authorities lack the hard data on new variants that might be used to justify aggressive measures to stop their spread.

  • Some U.S. pharmacies are beginning to get direct shipments of coronavirus vaccine doses next week in a strategy intended to simplify the ability to get shots, Amy Goldstein, Laurie McGinley, Lenny Bernstein and Lena H. Sun report. The government will also start reimbursing states for emergency expenses used to fight the pandemic.
     
  • More experts are recommending that members of the public wear medical-grade masks. But there’s still a shortage of N95 masks, the first choice for health-care providers, and some people may find it easier to find KN95s, the Chinese equivalent, Marisa Iati reports.
     
  • The lingering symptoms experienced by many covid-19 patients months after the initial infection have cast a new light on chronic fatigue sufferers, Kaiser Health News’s Kevin Cool reports. The fatigue and “brain fog” that many long-haul covid-19 patients report are standard features of myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS, a condition that lacks a biomarker and was long seen as a behavioral problem. Recently, however, attitudes about chronic fatigue have started to change, a shift that could be pushed along by new research into long-term covid-19 outcomes.

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