When the pandemic officially ends, millions of people are expected to lose Medicaid benefits as regular reviews for qualification begin again.
These reviews were put on hold during the COVID-19 pandemic through a U.S. Department of Health and Human Services (HHS) public health emergency declaration that prevents anyone on Medicaid from losing coverage. Currently, that emergency is set to expire April 16, though it can be extended for another 90-day increment.
States have a year to go through the process of reevaluating individuals and sending them documents, according to NPR. HHS has said it will give states 60 days’ notice before ending the emergency period.
To provide extra coverage while evaluations were on hold, Congress gave states billions. This money is set to dry up at the end of the quarter when the emergency period expires. Medicaid officials say the money will run out faster than it takes to review eligibility for millions of people.
According to a report from the Urban Institute left-leaning think tank, an estimated 15 million people younger than 65 could lose their Medicaid benefits once the emergency ends. Daniel Tsai, director of the Centers for Medicare and Medicaid Services and CHIP Services, said that estimate is a “helpful grounding point to motivate everybody,” but did not provide an estimate from the agency.
As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled in Medicare according to the Centers for Medicare & Medicaid Services. The program serves a wide population that includes seniors, disabled persons, pregnant women, children and adults. Enrollment reached record highs during the pandemic. Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage for those with a low income. Together, they work to provide Americans with health coverage.
As for Medicaid, “people could lose their coverage if they earn too much or don't provide the information their state needs to verify their income or residency," said NPR.
At the end of the emergency program, Tsai said no one knows what will happen.
Most people who would lose Medicaid coverage would be eligible for other insurance options, including subsidized plans on the Affordable Care Act marketplaces.
Tsai said state officials worked to prevent unnecessary coverage loss by attempting to ensure enrollees’ contact information is up to date, monitoring rates of unreturned mail, working with insurers covering Medicaid enrollees, and conducting “shadow checks” to get a sense of who doesn't qualify.
Some enrollees might even be renewed automatically if states verify they qualify.
Income limits for Medicaid vary by state and eligibility group. In Virginia, a state with expanded programs through the ACA, adults without children had to earn less than $1,428 per month to qualify in 2021 and in Texas, adults without children didn’t qualify at all.
Although agencies have been preparing to start reviewing eligibility again, notifying individuals of their coverage status and sending renewal documents was a challenge even before the pandemic. Often, letters delivered by mail go unreturned or end up at the wrong address.
In Colorado, officials are expected to review the eligibility of more than 500,000 people. Of those, 30 percent of them are at risk of losing benefits because they haven’t responded to requests for information, close to the 40 percent who are expected not to qualify based on income.
As states gear up to begin reviews again, many Medicaid agencies are short-staffed.
Tsai said it is typical for “some amount of folks who lose coverage for administrative reasons for some period of time,” and that his agency wants to minimize that, despite the challenges ahead.
Officials and groups who work with people living in poverty are still concerned low-income groups will become uninsured when the emergency ends, especially since Medicaid enrollees have a lower vaccination rate than the rest of the country.
“Even short-term disruptions can really upend a family,” said Jessie Mandle, deputy director of Voices for Utah Children, an advocacy group.
Stephanie Burdick, a Medicaid enrollee in Utah who advocates on behalf of patients with traumatic brain injuries, experienced period loss of her Medicaid coverage before the pandemic.
“I really do remember being at the pharmacy not being able to afford my medication and just sobbing because I didn't know what to do about it,” she said. “It was horrible.”
While some are concerned about what will happen to people who need medical services if their coverage lapses, others believe it is “responsible” to stop providing coverage for ineligible people.
“There's no end in sight. For two years, it's still a quote-unquote ‘emergency,’” said Stewart Whitson, a senior fellow with the Foundation for Government Accountability, a conservative think tank has argued that states can legally begin trimming people from Medicaid rolls.
“This is the kind of problem that just grows worse every day,” he said of not removing ineligible people. “At the beginning of the pandemic, people were in a different position than they are now. And so responsible legislators and government officials in each state have to look at the facts as they are now.”
However, Tsai said states must keep people enrolled through the emergency in order to get enhanced Medicare funding.
“Those two things are interlinked,” he said.
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