When the Coronavirus Emergency Concludes, Millions May Face Loss of Medicaid Benefits


As the safeguards implemented when the coronavirus outbreak first began are ending, states are anticipating the withdrawal of Medicaid benefits for a substantial amount of individuals.

In April, millions of people in the US with low incomes will face the possibility of not having access to healthcare and the potential of incurring high medical expenses due to the upheaval.

A financial burden will be placed on medical institutions, health practitioners, and other entities that are dependent on Medicaid reimbursement, a collaboration between the federal government and individual states that aids those with lower incomes and disabilities.

It was nearly three years ago when the pandemic caused a drastic economic downturn, so the federal government decided to provide states with additional Medicaid funding as long as they didn’t reduce the number of people enrolled.

In December, a law was passed that will start to decrease the amount of money available over the next year and requires states to start denying Medicaid to those who no longer fulfill the qualifications.

Currently, states have to confront major difficulties: ensuring that those entitled to Medicaid remain enrolled and linking the remaining population to other forms of insurance.

Prior to the pandemic, states had difficulty staying in touch with Medicaid enrollees who, on occasion, lacked a permanent residence or web access, could not converse in English, or had other needs that they considered to be more urgent than medical insurance.

Dana Hittle, Oregon’s interim Medicaid director, reminded that the Medicaid unwinding may not be attractive or elegant, but they are doing their utmost to ensure nobody is left behind.

The percentage of Americans without insurance is currently at a record low of 8%, so the impact of a reversal will be significant.

The Biden administration anticipates that 15 million enrollees, representing 17% of the total, will no longer be covered by Medicaid or the Children’s Health Insurance Program (CHIP) as the two programs return to pre-pandemic operation. Close to half of the 15 million will be dropped due to procedural issues such as not responding to requests to confirm personal data, according to a federal report.

Particular areas may experience a sharp increase: Medicaid and CHIP enrollment in Nevada grew by 47% since February 2020. Numerous people enrolled when the state’s joblessness rate rose to almost 30% as the pandemic began.

It is commonplace for individuals to enter and exit Medicaid on a regular basis. As states have a great deal of autonomy when it comes to running their Medicaid programs, a significant amount of “churn” is experienced as people’s income levels modify and they become either qualified or ineligible for the program.

It will take longer than a year to complete the unravelling.

Individuals who have had their Medicaid coverage revoked in the more than 30 states that are under the jurisdiction of the federal marketplace have until July 31, 2024, to apply for ACA coverage, as per the announcement from CMS on Jan. 27. It is unknown if the same extended open-enrollment period will be available for the state-based marketplaces.

The states that have taken drastic steps to make sure people remain insured are still concerned that the transition will be difficult.

The California state government has predicted that, out of the 15 million people enrolled in Medicaid, at least 2 million will not have coverage anymore due to lack of eligibility or not completing the renewal process.

Mark Ghaly, Secretary of California’s Health and Human Services, stated that the journey ahead would be tricky, and that they are doing everything they can to be ready for it.

In a collective effort, states are recruiting Medicaid health plans, physicians, hospitals, state-run health insurance marketplaces, and several non-profit organizations, such as educational facilities and churches, to reach out to those who may be in danger of losing their coverage.

In order to be able to reach out to those who are enrolled, states will be utilizing a variety of media platforms such as social media, television, radio, and billboards, along with websites and mobile phone applications. This is aside from the traditional use of letters and emails.

The state of Nevada has created a mobile application for communication with members, yet only 15,000 of the 900,000 Medicaid enrollees have registered for it thus far.

A state report released in November noted that Nevada’s transient population has made it hard to keep accurate contact info, and that at least a quarter of the letters sent to enrollees have been returned due to incorrect address.

Starting April 1, states are authorized to remove ineligible Medicaid recipients, but they are prohibited from canceling any enrollees simply because a piece of mail was returned as undeliverable until they have made a bona fide attempt to get in touch with the person through other methods, such as a telephone call or email.

In order to minimize the amount of disturbance, the legislation necessitates that states offer Medicaid and CHIP coverage to children for a duration of twelve months no matter what alterations in circumstances may occur. However, this stipulation will not be put into effect for around a year.

Jack Rollins, director of federal policy at the National Association of Medicaid Directors, stated that Medicaid recipients will have a minimum of 60 days to submit responses to requests for info prior to being taken off the program.

Governments will take advantage of IRS and Social Security Administration databases to validate income eligibility of enrollees in order to renew their coverage without having to contact them. Nevertheless, some states are not making the most of these databases.

The federal Centers for Medicare & Medicaid Services will be overseeing the procedure and states must present their plans for dissolution by February.

It is evident that certain states are taking more effective measures than others to ensure people remain insured.

Oregon has devised a plan to ensure Medicaid coverage for their minors up to the age of 6 and allow all other enrollees a maximum of two years of eligibility, regardless of their income status and without them having to go through the application process again. No other US state offers more than a single year of guaranteed eligibility.

Oregon has established a subsidized health plan that would provide coverage to citizens whose annual income is below 200% of the federal poverty level ($29,000 for an individual), and the benefits of the program would be akin to those of Medicaid with minimal or no cost for enrollees, according to state officials.

The state of Rhode Island plans to transition individuals who have outgrown their Medicaid eligiblity and make less than 200% of the poverty rate into an Affordable Care Act (ACA) plan. To make this process smoother, the same company operates both healthcare plans. Additionally, the government will cover the first two months of premiums.

In California, those who don’t meet the requirements for a free health plan will be offered a subsidized private plan through Covered California, with a monthly premium that could be as low as $10, according to Jessica Altman, executive director of Covered California. (Altman’s father, Drew Altman, is president and CEO of the Kaiser Family Foundation, of which the KHN program is editorially independent.)

Altman asserted that their goal is to make the process of obtaining coverage more straightforward.

Experts are concerned about what the future holds for those enrolled in Florida Medicaid.

In Florida, a different process is used for ACA plans compared to other states. As there is no state-run ACA marketplace, citizens must use the federal exchange. This can lead to a lack of efficiency when transitioning between Medicaid and the marketplace, according to Jodi Ray, the director of Florida Covering Kids and Families, a non-profit organization that assists people in finding coverage.

Ray highlighted the issue that Florida does not make full use of official databases to assess the incomes of enrollees as much as other states do. “We require enrollees to undertake an extensive process for renewal instead of using all the accessible data,” he commented.

She stated that, typically, Florida takes several weeks to process Medicaid applications, whereas other states can complete the same task in merely one day.

The challenge of reaching out to potential Medicaid enrollees is demonstrated by Florida’s devised plan. According to the plan, since 2020, 850,000 cases have been uncovered in which recipients failed to reply to inquiries.

When contacted, representatives from the Florida Medicaid program could not be reached for comment.

As government representatives endeavor to untangle the mess, healthcare suppliers are getting ready for the repercussions.

According to Dennis Sulser, the head of Youth Dynamics based in Billings, Montana, some children receiving mental health services through Medicaid will likely be excluded from coverage due to the complexities of the system.

The potential result of this situation could be that patients are unable to afford their payments and the non-profit organization is struggling to make sure that children do not experience any delays in their treatments.

Sulser commented that if a child in their group home care were released before obtaining all of the necessary support, it could have a devastating effect.

This report was put together by Daniel Chang in Hollywood, Florida; Angela Hart in Sacramento, California; Katheryn Houghton in Missoula, Montana; Bram Sable-Smith in St. Louis; and Sam Whitehead in Atlanta, all of who are correspondents for KHN.

Kaiser Health News is a health policy news service which operates at a national level. It is a program which is not linked to Kaiser Permanente, and is instead editorially independent of the Henry J. Kaiser Family Foundation.