Healthcare provider perspectives on the end of the COVID-19 Medicaid continuous enrollment provision: Implications for childhood cancer survivors.

264 Background: In response to the COVID-19 pandemic, the federal government conditioned enhanced Medicaid funding on states maintaining continuous enrollment of beneficiaries—i.e., the Medicaid Continuous Enrollment Provision (MCEP). Established to guarantee uninterrupted coverage during a period of public health uncertainty, this policy expired in March 2023. States then resumed often burdensome eligibility redeterminations, with wide variation in implementation. As a result, individuals who no longer met eligibility—or failed to complete renewals, even if still eligible—faced disenrollment. Childhood cancer survivors (CCS), a medically vulnerable group requiring stable insurance for lifelong care, may be uniquely affected by this shift. However, little is known about the knowledge and perception of the end of MCEP among healthcare providers and staff who care for this population. Methods: Semi-structured interviews were conducted with 22 providers and staff who care for CCS: oncologists (18%), nurses/advanced practice providers (APPs; 36%), social workers (41%), and financial counselors (5%). Participants were recruited from Medicaid expansion (55%) and non-expansion (45%) states. Most were aged 40–54 years (50%), women (91%), and non-Hispanic White (73%). Additionally, 41% practiced in both pediatric and adult care settings. Interviews were recorded, transcribed, and analyzed using a thematic approach with both deductive and inductive themes. Results: Awareness of the MCEP varied; half of the participants were unaware or only vaguely aware of it. Among those with some familiarity, 23% (5/22) felt well-informed; social workers generally had greater familiarity than oncologists and nurses/APPs. Regardless of awareness, most stakeholders viewed the MCEP as beneficial to CCS for maintaining continuous coverage and care. Participants expressed concerns about the consequences of the termination of the MCEP—particularly for young adult survivors > 18 year who already face challenges navigating Medicaid renewals or securing alternative coverage, often for the first time. Participants described care disruptions due to coverage loss and financial strain (e.g., inability to pay out-of-pocket). Several noted that CCS were inadequately informed and unprepared for the transition, and that Medicaid processing backlogs have delayed re-enrollment and access to care post-COVID for some survivors in their care. Conclusions: Healthcare providers of CCS had varied awareness of the MCEP but widespread concern about its termination. Findings suggest the need for provider-directed education on policies that can optimize financial navigation to sustain coverage and care continuity for economically disadvantaged CCS in the post-COVID Medicaid landscape.