The Biden administration should end a COVID-19 Public Health Emergency (PHE) provision due to it leading to increased Medicaid enrollment and "costing states hundreds of millions of dollars," according to a letter sent to President Joe Biden by Gov. Kay Ivey and 24 other governors on Monday.

The PHE was a provision of a 2020 COVID-19 relief bill requiring that states keep individuals continuously enrolled in Medicaid through the end of the month in which the COVID-19 PHE ends in exchange for more federal funding, according to Roll Call.

The provision also required states not to remove ineligible enrollees in exchange for the extra federal funding while the PHE was still in effect.

The PHE has been extended until at least January 11, 2023, but will likely be extended again by the federal government for another three months.

"Since states have not received notice the PHE will expire in January, we are acting under the assumption that it will be renewed for 90 days and expire in April 2023, unless it is extended again," the Governors wrote in the letter. "We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration. The PHE is negatively affecting states, primarily by artificially growing our population covered under Medicaid (both traditional and expanded populations), regardless of whether individuals continue to be eligible under the program." 

The governors wrote that "while the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily."

"Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must account and pay for their Medicaid enrollment in our non-federal share," the governors wrote in the letter. "This is costing states hundreds of millions of dollars. Since the beginning of the pandemic, states have added 20 million individuals to the Medicaid rolls (an increase of 30%) and those numbers continue to climb as the PHE continues to be extended every 90 days. We urge you to end the national emergency and the PHE in April and provide states notice of those intentions well in advance to allow us to adequately plan for the future."

A spokesperson for Ivey didn't return a request for comment on Tuesday.

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