Large-scale Loss of Medicaid Coverage as States Review Enrollment Lists

States are currently conducting comprehensive reviews of their Medicaid rolls, resulting in a significant number of Americans losing their coverage. Surprisingly, the vast majority of individuals who have been disenrolled thus far experienced coverage termination due to administrative technicalities.

 

Since the expiration of pandemic protections on April 1, over 600,000 Americans have been stripped of their Medicaid coverage, according to a recent analysis by KFF Health News. State data reveals that the majority of individuals were removed from the Medicaid rolls due to failure to complete required paperwork.

Under normal circumstances, states regularly review their Medicaid enrollment lists to ensure that recipients still qualify for coverage. However, the pandemic-induced pause on these reviews allowed the health insurance program for low-income and disabled Americans to continue covering individuals even if they no longer met the eligibility criteria.

Now, states are engaged in the process known as “Medicaid unwinding,” where they carefully assess each enrollee to determine who should remain covered and who should be removed. The primary reasons for coverage loss are technicalities, rather than state officials determining that individuals exceed the Medicaid income limits. Data from 11 states, analyzed by KFF Health News, indicates that four out of every five people who lost coverage failed to return the necessary paperwork or omitted required documents.

The significant number of individuals losing Medicaid coverage has raised concerns among lawmakers and advocates, leading some states to consider pausing the unwinding process. In Indiana, for example, 53,000 residents lost coverage within the first month of the unwinding, with 89% experiencing procedural issues such as not returning renewal forms. State Representative Ed Clere, a Republican, expressed shock at these “staggering numbers” during a Medicaid advisory group meeting on May 24. He repeatedly questioned state officials about forms being sent to outdated addresses and urged them to provide individuals with more than a two-week notice before canceling their coverage.

Fortunately, individuals who have been disenrolled still have the opportunity to appeal and potentially have their coverage restored within a 90-day window. In New Hampshire, around 13% of individuals deemed ineligible in the initial month have requested additional time to submit the required records. The goal is to prevent eligible individuals from losing their Medicaid coverage unnecessarily.

State Representative Clere emphasized the need for immediate changes by Indiana’s Medicaid officials to avoid further uninsured individuals. In response, an official acknowledged that improvements would be made over time but acknowledged the concern of “learning” at the expense of those losing coverage.

 

The loss of Medicaid coverage for hundreds of thousands of Americans, primarily due to administrative technicalities, has prompted calls for reform and improved processes to ensure eligible individuals do not face unnecessary obstacles in maintaining their healthcare coverage.  

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Written by: Benavest

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Health Insurance

June 1, 2023

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