Thousands of Maryland residents who became eligible for government-supported health insurance during the COVID-19 pandemic may soon find that coverage terminated — a matter of great concern for health systems such as Johns Hopkins Medicine that have provided first-time care to many patients.

Throughout the pandemic, the Centers for Medicare & Medicaid Services (CMS) has waived certain Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions, expanding access to health care throughout the nation.

At present, the federal public health emergency (PHE) and the flexibilities it has offered will remain in place at least until mid-April 2023. How the U.S. fares against COVID-19 this fall and winter will help determine whether the emergency needs to be renewed, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra told reporters in October.

JHM clinicians, administrators and support staff are working to make sure that patients insured through Medicaid understand their health insurance status, and what they must do either to re-enroll or to seek other forms of coverage, according to Nicki McCann, vice president of provider/payer transformation for the Johns Hopkins Health System.

Roughly 1.7 million people in Maryland — about 24% of the population — have insurance coverage through Medicaid, a figure that grew by roughly 300,000 during the PHE. When the PHE ends, McCann expects many recent enrollees will no longer qualify due to such reasons as changes in their income.

“Providers need to tell patients who are no longer eligible about other resources, such as the Maryland Health Benefit Exchange, that can help them get affordable coverage,” McCann says, adding that Johns Hopkins financial counselors can assist in that enrollment process. (Clinicians and administrators can also visit the government’s Health Insurance Marketplace for additional information.)

Since the beginning of the PHE, the HHS has promised to give 60 days’ notice before lifting the emergency declaration so that states and clinical teams can prepare for a return to normal operations.

Psychiatrist Kenneth Stoller, director of the Johns Hopkins Broadway Center for Addiction, says that the need to start the process of Medicaid redetermination now is critical for patients at the center who obtained both their insurance — and comprehensive health care — for the first time only during the pandemic.

“Our patients come here for their substance use disorder,” he says. “But with all of their other problems, and with how often we see them, we certainly function as a health care home. One of the first things we do is make sure they have primary care providers and appointments to see them. We start addressing some long and ignored health problems, including mental health.”

Many patients are unfamiliar with the steps they need to follow in order to re-enroll for coverage, Stoller says. “And because of the housing instability in this population, they probably have not been getting any mailings from the state regarding this.”

Kristin Topel, program manager of Hopkins Community Connection, recommends that providers and clinical staff regularly check redetermination dates with their patients “before getting to the moment at an appointment where you realize suddenly, ‘Oh, this coverage is inactive,’ and they aren’t able to be seen.”

“These next few months are critical,” says Barry Solomon, division chief of general pediatrics. “We should use every health care encounter as an opportunity to inform families and provide resources.”

“The team at our practice has been helping families go through this process in an anticipatory way,” says pediatrician Sarah Polk, medical director of the Children’s Medical Practice clinic at Johns Hopkins Bayview Medical Center.

She notes that immigrant parents of Medicaid-eligible children encounter structural barriers to enrollment often related to language access and verification of identity.

“We pour a lot of resources into assisting families with insurance,” she says. “I am not so panicked about our practice, but I know that because those resources are not widely available, it’s a huge problem for the community at large.”