In the six months since states began double-checking the eligibility of people enrolled in their Medicaid programs for the first time in three years, more than 8.5 million Americans have lost their Medicaid benefits.
Based on enrollment numbers at the start of the year, that means roughly 1 in 10 people covered by Medicaid have lost their health insurance in a matter of months. After the US saw its uninsured rate hit historic lows during the pandemic, millions of the most vulnerable Americans are now falling off the rolls — with no assurance they will be able to find another form of coverage.
Worse, many of those losing coverage are losing it because of administrative hiccups and would otherwise be eligible — a problem that is disproportionately impacting children.
We won’t know until next year’s national insurance surveys how many people simply ended up uninsured and how many people successfully enrolled in another form of health coverage even as they lost their Medicaid benefits. But it is safe to expect that millions more Americans are now uninsured than were at the beginning of the year.
The health effects of this massive loss in health insurance will take years to be realized. But we know that having Medicaid means people are more likely to see a doctor and keep up with managing chronic conditions. The program helps people live longer. So losing coverage will make it even more difficult for a population that already struggles with its health to stay well.
Here’s why this is happening: During the pandemic, Congress approved an emergency provision that prevented almost anyone from losing their Medicaid coverage. Even if you had a change in income or life circumstances that in normal times would have led to you leaving the program, you were allowed to stay as long as that emergency policy was in place. But that provision expired earlier this year, part of the government standing down from its pandemic footing, and states were tasked with double-checking the eligibility of every person who was on their Medicaid rolls — a process referred to as unwinding. Starting in April, they could remove people who they found were no longer eligible.
So far, these are the aggregate enrollment losses by state, via KFF:
Before unwinding began, the Biden administration and outside experts estimated that up to 15 million people could lose their coverage during the unwinding process. We are now more than halfway to that worst-case scenario, with at least six months to go in most states.
The fear is that many people would end up losing coverage not because they were actually no longer eligible for Medicaid but because they got caught in some kind of bureaucratic snag. States are supposed to do as much as they can to check people’s eligibility with data they have on hand (tax data, information from food stamps and other welfare programs, etc.) but states are limited in their actual capacity to perform those automatic checks. According to KFF, less than one-third of enrollment checks have been completed through automatic “ex parte” renewals.
If a person’s eligibility can’t be confirmed automatically, that’s when things get dicey. States have to make sure they know about the unwinding process in the first place, they have to have up-to-date addresses and contact information to get in touch with people, and then people have to successfully either log onto an online portal or send documentation through the mail to confirm their eligibility. There are plenty of places where the proverbial ball could be dropped, either by the state or the enrollee.
Based on the available data, that has been happening quite a lot. In most states, more than half the people who have been kicked off Medicaid have lost coverage for an administrative reason — meaning somewhere along the way, there was an issue with their paperwork, not that they were no longer eligible.
Experts are particularly concerned about children losing coverage when they shouldn’t — and for good reason.
The Biden administration announced last month that it had detected a problem with how states were conducting their eligibility checks. A majority of states, as it turns out, were automatically disqualifying everybody in a family if they found that one person (most likely a parent) was no longer eligible for Medicaid.
That approach might simplify the process for states, but it risks kicking eligible children off the program. Most states have more generous eligibility rules for children than they do for parents. So while a parent may no longer qualify for Medicaid, their child still might. The administration has demanded states take steps to make sure they are evaluating the eligibility of each individual, to ensure children are not being unnecessarily removed from Medicaid
The data we have on how kids are faring during unwinding is concerning. Experts expect that most children who are legitimately no longer eligible for Medicaid should be eligible for the Children’s Health Insurance Program (CHIP) in the states that run a separate CHIP program. (In other states, Medicaid and CHIP have been integrated.) According to the Georgetown Center on Children and Families, while more than 1 million children have lost Medicaid in those states over the past six months, CHIP enrollment has stayed relatively flat.
Altogether, more than 1.7 million American children have lost their Medicaid benefits this year:
In states that are breaking out renewal data by age, children account for a substantial share of the people who are losing Medicaid benefits:
Some coverage losses were inevitable during the unwinding process. But the US seems to be failing in the pursuit of minimizing the unnecessary losses, with the country’s children bearing a significant part of that failure. States and the Biden administration say they are trying to stop the bleeding. Time will tell if they can do so successfully — or if it’s already too late.