- Between 5.3 million and 14.2 million people may lose their Medicaid coverage in the next year as provisions put in place during the pandemic start to expire.
- This can disrupt medical care for many low-income individuals and others.
- Some newly uninsured people may be to seek care at emergency departments or forgo unaffordable prescription medications, according to experts.
Millions of Medicaid members are expected to lose coverage beginning in April when a provision designed to keep states from kicking people off the program during the COVID-19 public health emergency comes to an end.
This will disrupt medical care for many low-income individuals and others, with some newly uninsured people forced to seek care at emergency departments or forgo unaffordable prescription medications.
In addition, hospitals — especially rural ones — could see an increase in debt as they assume costs for treating a wave of uninsured patients.
Community health centers will also be impacted when millions of patients lose Medicaid coverage. This will affect the centers’ revenue and their ability to help medically underserved communities.
What is Medicaid continuous enrollment?
As part of the Families First Coronavirus Response Act (FFCRA) passed in March 2020, states were required to keep most members continuously enrolled on Medicaid. In exchange, states that enacted this and other provisions received enhanced federal funding.
Prior to this, states periodically re-evaluated members’ eligibility, including their income. If people still met the eligibility requirements at the time of this redetermination, their coverage would continue.
Since the start of the pandemic, Medicaid/CHIP enrollment jumped to 90 million, an increase of 19.8 million people, reports the Kaiser Family Foundation. This was largely due to the continuous enrollment provision.
CHIP is the federal Children’s Health Insurance Program, which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
Sara Rosenbaum, JD, a professor of health law and policy at the Milken Institute School of Public Health at George Washington University in Washington, D.C., said many people needed Medicaid during the pandemic because they lost their jobs.
“And because of the continuous enrollment provision, once you came onto the program, you stayed on,” she said. “So for the first time, a lot of low-income people had something that we’re used to in the employer market — stable coverage.”
Without continuous enrollment, a number of things can cause a person to lose Medicaid coverage, such as fluctuations in their income due to a pay raise or taking a temporary second job.
Administrative issues can also cause a person to get kicked off Medicaid, a phenomenon known as “administrative churn.”
For example, this can occur if a member or the state makes a mistake during the redetermination process, or if a person misses important notifications because they moved to a new address.
With the COVID-19 public health emergency set to end in May, the Medicaid continuous enrollment provision has been scheduled to end on March 31.
As a result, starting April 1, states can start processing Medicaid redeterminations and disenrolling members who no longer qualify. They will have 14 months to review members’ eligibility.
After members receive a notification from their state of the re-evaluation process, they will have a certain number of days to provide requested information. If members don’t respond within that time frame, they can lose their Medicaid coverage.
How many will lose coverage?
KFF estimates that between 5.3 million and 14.2 million people will lose their Medicaid coverage during the 12 months after the end of continuous enrollment.
This is lower than an estimate from the Department of Health and Human Services (HHS) suggesting that as many as 15 million people will lose Medicaid or CHIP coverage.
About 6.8 million people would be disenrolled even though they are still eligible, the department estimates.
David Craig, PhD, a professor of religious studies at Indiana University in Indianapolis, said the impact is likely to vary across the states.
“Medicaid is operated very differently in different states,” he said, “So depending upon how the rules [in certain states] work, there may be bigger barriers that people are facing.”
Some groups will likely be impacted more than others.
“Post-COVID has been all about getting back to normal,” said Craig, “but normal in Medicaid wasn’t working for a lot of people.”
In particular, he said people who are homeless or have no fixed address may not receive notifications about the need to submit information about their income. Also, people who came onto Medicaid while continuous enrollment was in place may not even know how the redetermination process works.
Rosenbaum said some states may be more interested than others in keeping people on the Medicaid program — such as Massachusetts and Vermont. These will be more proactive in getting the word out to members about the end of continuous enrollment.
“But there’s only so much everybody — even a really conscientious group of state officials — can do,” she said. “There’s also the problem of having to start up [administrative] machinery this complicated after a three-year hiatus.”
Overall, Rosenbaum thinks the estimates of how many people will lose coverage may be too low, at least in the short term.
“In a year or two from now, the net loss may not be as big,” she said, “but in the interim period, we’re going to see a lot of people get knocked off [Medicaid], and then come back when they’re not able to access healthcare.”
In spite of the efforts of states and community organizations to inform people about the end of continuous enrollment, “unfortunately a significant number of people are going to learn the hard way,” said Craig, “which is showing up at the pharmacy or the doctor’s office and learning they don’t have coverage.”
How will people be affected?
Based on pre-pandemic data, a large number of people will likely be uninsured for a period of time after they lose Medicaid coverage.
A report by KFF using 2016-2019 data found that roughly two-thirds of people disenrolled from Medicaid/CHIP had a gap in coverage in the following year.
Around four in 10 who were disenrolled eventually re-enrolled in Medicaid/CHIP within a year (aka “churn”), the report found.
Many people disenrolled from Medicaid are expected to obtain other coverage, such as employer-sponsored insurance.
In addition, some people will qualify for a premium tax credit to offset the monthly cost of a health plan purchased through the Health Insurance Marketplace.
However, HHS projects that 383,000 people who lose coverage would have incomes too high to qualify for Medicaid but too low to receive Marketplace tax credits.
One thing that Rosenbaum and others are concerned about is the impact that loss of coverage will have on people who get care from specialists, such as those with chronic conditions like diabetes, heart disease or depression.
“If you’re fortunate and your main source of care was at a community health center, you can likely continue to get primary care there,” she said, “but if you have any condition that requires a specialist, you may be out of luck.”
People who lose coverage may also be unable to afford vision or dental care, or prescription medications.
Craig said one of the positive things that has come out of continuous enrollment is that over the past three years, many people have been able to establish a relationship with a primary care provider and receive regular care.
“So what happens when you lose both your coverage and the relationship you’ve established with your primary care provider?” he said. “This is not only disruptive to your health, but it’s also disruptive to your sense of belonging and your sense of security — such as not worrying about bankruptcy if you need care.”
Don’t get caught without coverage
Lynn Blewett, PhD, a professor of health policy at the School of Public Health at the University of Minnesota in Minneapolis, offered several tips for Medicaid members on how to navigate the end of continuous enrollment.
Make sure the state has your correct address.
States have different plans for how they will contact Medicaid members about what they need to do and the deadline for doing it.
But no matter the process, Blewett said it’s important to reach out to your state Medicaid office and update your address and phone number if it’s changed recently. That way, you’ll receive important notices.
When you get a letter, act fast.
“When you receive a letter, open it right away,” said Blewett, “because there will be a time period to respond in order to make sure you have continuous coverage.”
If you find out that your Medicaid coverage is going to end, look for new coverage as soon as possible.
Blewett said many people whose Medicaid coverage ends will qualify for employer-sponsored insurance or a subsidized premium on marketplace plans.
You will have a limited time to sign up for a health plan through your employer (if they offer it) or through the HealthCare.gov Marketplace.
“If you have problems figuring out how to fill out the [Marketplace] forms, there are navigators that can help you figure out your enrollment options,” said Blewett.
Search the HealthCare.gov online directory to find an agent, broker, or assister near you who can help with your application.
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