WASHINGTON — States are disenrolling residents from Medicaid at a breakneck pace, even though a large percentage of those losing coverage are still eligible for the program.
But the unique structure of the jointly run federal and state program means there’s little the Biden administration can do to prevent poor people from losing health care.
As of June 22, more than 1.5 million people in 25 states and the District of Columbia have been disenrolled from Medicaid through the unwinding of the pandemic continuous coverage provision, according to data from KFF, the group formerly known as the Kaiser Family Foundation. And as many as 17 million could lose coverage soon by the time the process concludes.
Across all states, 73 percent of those disenrollments are procedural terminations, meaning patients in question still qualify for Medicaid based on their income or disability status, but they may have missed a phone call from a state health official, could not verify income with a previous employer or dealt with some other procedural misstep that thwarted the process of reenrolling.
The disenrollments are happening in the context of the end of a continuous coverage requirement brought on by the COVID-19 public health emergency. That requirement barred states from removing anyone from their Medicaid rosters during the emergency. The end of the requirement in March means that Medicaid recipients must verify their eligibility or risk being cut from the program, and many red states see this as an opportunity to quickly cut costs and trim their Medicaid rolls.
The White House gave states a few months to prepare for the end of the public health emergency and the resumption of Medicaid renewals, but some policy experts say it was difficult for states to realize the downstream impact.
“It is hard to underestimate or underscore enough the historical, traumatic events that we are experiencing in the Medicaid base right now,” said Karen Shields, a former deputy director of the Centers for Medicare & Medicaid Services’ Center for Medicaid and CHIP Services under the Obama administration and now client engagement officer at Gainwell Technologies, a company that provides digital solutions to administer health and human services programs.
“The [coverage] grounds that we have made since the passage of the [2010 health care law] are quite frankly about to erode because we are not taking this problem seriously enough,” she said.
In Arkansas, for example, the state reported 72,802 beneficiaries had lost Medicaid coverage during the first month of redeterminations — 40 percent of whom were children and 72 percent of whom lost their coverage for procedural reasons.
But the Arkansas Department of Health defended these high numbers of procedural terminations by arguing that many residents simply chose not to turn in their Medicaid paperwork because they knew they no longer qualified. While these people may count as procedural coverage losses, they were aware of the process, argued Arkansas Department of Health communications chief Gavin Lesnick.
In Kansas, 89 percent of Medicaid enrollees who lost health insurance lost coverage for procedural reasons. Many were children who rely on parents or other caregivers to update their contact information with the state. More than 62 percent of KanCare enrollees are kids, and roughly 64 percent of KanCare sign-ups during the pandemic were children, according to data from the Georgetown Center for Children and Families.
Power of the purse
Biden administration officials and Capitol Hill lawmakers are quickly trying to figure out how many of these procedural terminations could have been avoided and what to do about it.
HHS offered states some new flexibilities earlier this month in an effort to stem the disenrollments.
This includes allowing managed care firms to complete Medicaid renewal forms on an enrollee’s behalf, allowing states to delay administrative termination for one month while the state conducts additional targeted outreach, and allowing pharmacies and community-based organizations to facilitate reinstatement of coverage for those who were disenrolled.
