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• Posted January 4, 2023

Millions Could Lose Medicaid by April as Pandemic Rules Ease

Millions of Americans are about to lose Medicaid coverage that they gained -- and maintained hassle-free -- through the pandemic.

The end-of-year spending bill that Congress passed will "unwind"a continuous Medicaid enrollment requirement that states had to honor to get additional federal pandemic funds, explained Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation (KFF).

"Essentially, if states took the enhanced federal funding, they were prohibited from dis-enrolling anyone from Medicaid, beginning in March of 2020,"Tolbert said.

As a result, Medicaid enrollment swelled by about 20 million people during the pandemic, as people who otherwise would have lost eligibility remained enrolled, KFF estimated. Currently there are nearly 84 million people with Medicaid coverage.

But starting on April 1, states can begin shedding their Medicaid rolls of people who no longer qualify, under the spending bill passed in December.

The U.S. Department of Health and Human Services (HHS) has estimated that about 15 million people are at risk of losing their Medicaid coverage, Tolbert said.

Many of these are folks who should have lost their coverage due to changes in their lives, except for the pandemic-era protections, Tolbert said.

"Maybe they got a new job that came with more income, or they had a change in family circumstances,"Tolbert said.

But HHS has estimated that almost 7 million out of the at-risk 15 million might lose coverage due to bureaucratic snafus or procedural snags, even though they still qualify for Medicaid, Tolbert said.

For example, their state's Medicaid program might not be able to find them and get the information needed to maintain their enrollment, said Eric Roberts, an assistant professor of health policy and management with the University of Pittsburgh School of Public Health.

Make sure your Medicaid info is up-to-date

"People might have changed addresses. They might have changed their cellphone number,"Roberts said. "Things like not getting mail at the address that was last registered in your Medicaid application forms, or not knowing how to provide updated documentation about income, could all present challenges to completing recertifications."

Some states are more eager to start shedding Medicaid recipients than others.

"Red states are probably going to be less lenient than blue states -- at least that's the expectation,"Roberts said.

The U.S. Centers for Medicare and Medicaid Services (CMS) "has recommended that states take a full year to complete this unwinding process and conduct redeterminations on everyone involved in the Medicaid program,"Tolbert said. "CMS requires that before anyone is terminated from coverage, the state has to do a full redetermination of eligibility for that individual."

However, some states like Ohio have already said they plan to speed their shake-up of the Medicaid rolls, Roberts noted.

"Look for states that were less partial to Medicaid expansion in the first place, or that may be undergoing fiscal pressures themselves -- the economy is starting to slow down, state revenues are starting to slow down,"Roberts said. "There may be some fiscal pressures for those states to accelerate the unwinding."

States more supportive of Medicaid might ease the process for program members, either by using other programs, like food stamps, to assess a person's financial status or by providing easy-to-return enrollment forms, Roberts said.

No one should count on such help, though. Being proactive could prevent unnecessary woes -- starting with reaching out to your state to make sure they know how to reach you.

"Make sure that the Medicaid agency has updated contact information,"Tolbert said. "If the individual has moved, if their phone number has changed or they got a new email address, and especially if they have moved residences, they should provide that information to their state Medicaid agency before they actually receive the notice about a renewal process."

Once you're sure the state program can reach you, be on the lookout for a renewal notice, Roberts said.

Obamacare might offer alternatives to some

"Most states are attempting to contact people who are enrolled in Medicaid to alert them that their eligibility is subject to redetermination,"Roberts said. "Read those letters. Respond to those letters."

Act fast. The notice will include deadlines for response, as well as a request for whatever updated financial and family information the state needs to complete your renewal, Roberts and Tolbert said.

If you're not certain of your eligibility, you could go to either HealthCare.gov or your state's health insurance marketplace and punch in your financial numbers, Tolbert said. Part of the marketplace process involves checking for Medicaid eligibility.

Another benefit of going to an Affordable Care Act ("Obamacare") marketplace is that you probably qualify for financial aid to help you pay for private insurance, particularly if you barely missed qualifying for Medicaid, Tolbert said.

"Some people may think that coverage in the marketplace won't be affordable to them,"Tolbert said. "But I think it's important to note that there were enhanced subsidies put in place first through the American Rescue Plan Act in 2021, and then those enhanced subsidies were extended for another few years through the Inflation Reduction Act."

"And so that does mean that people with incomes below 150% of the federal poverty level should have access to a zero-dollar plan in the marketplace,"Tolbert continued.

People should also talk to their employer, to see if their job offers insurance, experts said.

Roberts said he is particularly worried about seniors and the disabled for whom Medicaid provides coverage of long-term care services in either a nursing home or their own house.

"These individuals are actually subject to more stringent eligibility criteria in Medicaid,"Roberts said. "They have to prove they have low income and low assets, and eligibility renewals can be really complex for these populations just because of the amount of income and asset verification they have to go through."

Unfortunately, these are the people whose advanced age or disabilities might interfere with their ability to fill out complicated government forms.

"These individuals have this dual challenge of having more complex renewal requirements, and life circumstance and health circumstance issues that could make it harder for them to actually seek the renewal,"Roberts said.

More information

The U.S. Centers for Medicare and Medicaid Services has more about renewing your coverage.

SOURCES: Jennifer Tolbert, MPH, director, state health reform, Kaiser Family Foundation; Eric Roberts, PhD, assistant professor, health policy and management, University of Pittsburgh School of Public Health