How Medicaid redeterminations have impacted patients

During the COVID-19 pandemic, a provision of the Families First Coronavirus Response Act required state Medicaid programs to provide beneficiaries continuous enrollment to receive additional federal funds. However, this provision ended on March 31, 2023, and states began their Medicaid redetermination processes on April 1, 2023.

Since then, KFF data shows that over 20 million people have been disenrolled from Medicaid, and millions more could follow as states continue their redetermination processes. So far, states have reported renewal outcomes for two-thirds of Medicaid enrollees.

Children have been particularly impacted by the Medicaid unwinding, with almost 5 million having lost coverage since last year. Around 2 million of these children have been in Texas, Georgia, and Florida, states that have not expanded Medicaid under the Affordable Care Act.

According to a KFF analysis of state data, around 70% of people who were disenrolled lost coverage due to procedural reasons, including not returning required paperwork or technical glitches.

A new KFF survey also found that around half of Medicaid enrollees said they heard only "a little" or "nothing at all" about states disenrolling people from Medicaid after pandemic policies about continuous coverage ended.

Among those who were disenrolled, 70% said they became uninsured after losing Medicaid coverage. Of these respondents, 75% said they were either somewhat or very worried about their physical health, and 60% said they were either somewhat or very worried about their mental health. In addition, 56% of those who were disenrolled said they skipped or delayed needed care while they attempted to renew coverage.

Overall, 47% of those who were originally disenrolled are now re-enrolled in Medicaid, and 28% now have another form of insurance, including employer-sponsored insurance or Medicare. However, 23% of disenrolled Medicaid beneficiaries are now uninsured.

How providers and plans have been impacted by Medicaid redeterminations

Amid Medicaid redeterminations, some providers have faced an increased financial burden as more people lose coverage and become uninsured.

For example, Clinica Family Health, a community health center in Colorado, had to close a dental clinic and a home health program to reduce costs after 35% of its patients, or 13,000 people, lost Medicaid coverage. Clinica also ended walk-in clinic services and laid off some of its employees.

According to Clinica president and CEO Simon Smith, these changes helped the organization save $6 million, but it still has a monthly shortfall of $100,000. "It's really hard to keep up, to be perfectly honest," Smith said. "It's really hard to keep staff motivated."

In Texas, many federally qualified health centers took a financial hit from Medicaid redeterminations. Jana Eubank, executive director of the Texas Association of Community Health Centers, said that Medicaid coverage losses led community health center revenue to decline by $135 million on average. Several community health centers have also cut services and laid off employees. "Nationally, there's been some winners and some losers, and unfortunately Texas has been one of those states that have performed really poorly," Eubank said.

Separately, some health insurance companies that administer Medicaid benefits, such as Centene and Molina Healthcare, have said that coverage losses are higher than expected and that their risk pools are less healthy now compared to before redeterminations began. This Advisory Board resource also outlines three effects Medicaid unwinding has had on managed care plans.

"Churn is back into the space, and no insurance company likes churn," said Craig Kennedy, president and CEO of Medicaid Health Plans of America. (Lopes et al., KFF, 4/12; Weiland, New York Times, 4/16; Tepper, Modern Healthcare, 4/23)

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