Millions of Americans who gained Medicaid health insurance during the COVID-19 pandemic could lose coverage this year or next year when generous federal subsidies end, a new analysis has found.
Kaiser Family Foundation estimates 5 million to 14 million Americans could lose Medicaid when states begin to unwind coverage after the Biden administration declares the COVID-19 public health emergency is over.
The federal government provided billions in federal aid to states on the condition that they would not remove people from Medicaid until the public health emergency ends. The temporary measure to ensure Americans didn’t lost coverage during the pandemic has extended more than two years. Kaiser projects sign-ups for full and partial Medicaid coverage will have swollen by 25% to 110 million by September’s end.
It’s been a lucrative deal for states. States have collected more than $100 billion in Medicaid funds and fiscal relief over the past three fiscal years while spending a projected $47 billion to cover the pandemic Medicaid enrollees.
But the enhanced federal funding will cease during the quarter in which the public health emergency ends. The federal government will still pay a portion of the Medicaid tab for enrollees, but the federal match won’t be as generous. So some states might prioritize quick eligibility checks to ensure only those who still fully qualify continue in the program.
It’s a date state Medicaid administrators and health policy experts are closely watching.
The public health emergency is scheduled to end July 15, but every time a deadline has approached the U.S. Department of Health and Human Services has extended it another 90 days. HHS officials have said the administration will notify states 60 days before ending the emergency – which means the notification would need to come next week if the Biden administration intends to end the emergency in July.
When the emergency ends, state Medicaid agencies will have 12 months to check the eligibility of every person and notify those who no longer qualify.
People normally churn on and off Medicaid rolls when they gain or lose a job or family circumstances change. Many states are now checking mailing addresses and phone contacts of members to ensure they can quickly reach them when eligibility checks resume.
Enrollment experts encourage recipients to be prepared for and respond to mailings from state agencies to ensure their coverage is not improperly dropped. Others must brace for the possibility they will no longer qualify and will lose coverage. In such cases, enrollment experts can inform people about other coverage options such as the Affordable Care Act marketplace.
“That churn might happen again,” said Robin Rudowitz, Kaiser Family Foundation’s director for the program on Medicaid and the uninsured. “We know a lot of people may face barriers or red tape in terms of being able to maintain coverage, even if they’re eligible.”
The Kaiser report said populations most likely to lose coverage include adults who gained Medicaid eligibility under the Affordable Care Act, parents who are not disabled and some children.
Rudowitz said experts also will be tracking whether more people become uninsured after the eligibility checks resume. The number of uninsured Americans dropped to 8.8% at the end of 2021 as millions gained Medicaid coverage and the American Rescue Plan Act offered more generous Affordable Care Act marketplace subsidies that lowered premiums for many.
That could change when states resume eligibility checks and disenroll Americans.
“We’ll be watching is to see what happens with overall coverage and if there’s an uptick in the uninsured rate,” Rudowitz said.
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