Millions of Americans could lose Medicaid coverage

In 2020, states that received enhanced Medicaid funding were prohibited from dropping individuals from the program during the COVID-19 public health emergency. During the pandemic, Medicaid enrollment increased significantly, and over 91 million people were enrolled in either Medicaid or CHIP as of October.

However, the continuous coverage requirement recently ended on March 31. If someone is ineligible for Medicaid, they will have until July 31, 2024, to sign up for coverage via the federal Affordable Care Act marketplace.

Although health officials have said they are working to ensure that people don't lose coverage, a KFF Health News (KHN) analysis of data from 14 states suggests that over 600,000 Americans have lost Medicaid coverage since April 1. In addition, tens of thousands of children are losing coverage, even though some may still qualify for Medicaid or CHIP.

Overall, around 15 million people could lose coverage over the next year as states review individuals' eligibility.

While some people may lose coverage due to ineligibility, others will lose coverage due to "administrative churn," which refers to clerical issues that could prevent people from getting services. These issues include address changes, a lack of contact information, or other struggles with the renewal process.

In addition, many people are simply unaware of the potential changes to their Medicaid coverage. According to a recent KFF poll, two-thirds of Medicaid enrollees said they were "not sure" if states could remove people from Medicaid if they were no longer eligible or if they had not completed the renewal process. Almost half said they had never been through the renewal process before since it was on hold during the pandemic.

"The KFF data was, I think, alarming, but not particularly surprising given this has been the concern that a lot of policymakers have had throughout this," said Louise Norris, a policy analyst for HealthInsurance.org. "We've known for a long time that this is eventually going to happen, especially throughout this part of this year."

According to a KHN analysis of data from 11 states, 80% of the people who have lost coverage so far either never returned paperwork for renewal or did not have certain required documents.

For example, in Indiana, 53,000 people lost Medicaid coverage during the first month of the state's eligibility review, with 89% losing coverage due to procedural reasons.

What does this mean?

Indiana state Rep. Ed Clere (R) said the number of people losing coverage was "staggering" and could significantly impact patients' health down the line, especially if they defer care due to lack of coverage.

He's worried the cancellations could trigger "an avoidable revolving door," where some people dropped from Medicaid will forgo filling prescriptions and cancel doctor visits because of costs. "Months down the line, after untreated chronic illnesses spiral out of control, they'll end up in the emergency room where social workers will need to again help them join the program," he said.

Although Indiana's Medicaid officials have said that they'll learn and improve the renewal process over time and advocacy coalitions in other states are helping families appeal their coverage decisions, Clere has pushed for more immediate changes to prevent people from losing coverage unnecessarily.

"I'm just concerned that we're going to be 'learning' as a result of people losing coverage," he said. "So I don't want to learn at their expense." (Choi, The Hill, 5/29; Recht, KFF Health News, 6/1)

With the COVID-19 public health emergency (PHE) ending in May, several pandemic-era healthcare provisions and waivers, including for vaccines, telehealth, insurance coverage, and more, have also ended — leaving patients with higher costs and more difficulty accessing care.