Eight months after states started dropping millions of low-income families from Medicaid rolls, grassroots groups say they are leading the push to re-enroll people denied coverage for bureaucratic reasons.
Nationwide, more than 12.5 million people have lost coverage since April. That’s when the federal pandemic provision that had required states not to drop anyone from the rolls expired and states restarted income eligibility checks.
Federal officials over the summer allowed states to exercise flexibility to avoid potentially unnecessary coverage losses, and mailed letters to governors warning that high numbers of removals for procedural reasons and long wait times could violate federal rules.
Still, as of Dec. 13, 71% of the people who were dropped lost their coverage through “procedural” disenrollments — that is, they were missing paperwork or otherwise didn’t complete the renewal process by a specified date — according to health policy research organization KFF.
Many of those people may be eligible for coverage, but struggle to get the paperwork through state bureaucracies.
Children, young adults, and Black and Hispanic people are overrepresented on the Medicaid rolls, compared with their share of the overall population. A federal Office of Health Policy brief published in August 2022 ahead of the unwinding estimated that nearly one-third of those predicted to lose coverage would be Hispanic and another 15% Black — groups with health disparities that were magnified during the pandemic. About 60% of Medicaid enrollees are Black, Hispanic, Asian or multiracial.
More than 2.4 million children have lost coverage. On Monday, the U.S. Department of Health and Human Services issued another warning, mailing letters to governors of nine states — Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas — with the highest rates of children dropped from the rolls.
Officials urged those states, which together have dropped 60% of the children who have lost Medicaid coverage nationwide, to use flexibility provided by federal officials to “help prevent children and their families from losing coverage due to red tape,” noting the efforts are “especially important for children and families of color.”
The department also noted that the 10 states that have not expanded Medicaid — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming — “have disenrolled more children than those that have expanded combined.”
Federal officials also announced that relaxed rules that allowed automatic renewals will be continued through the end of 2024 to give states more time and keep more families covered.
States have released online tools to help local leaders and providers offer guidance on how to enroll. Texas, for example, created “ambassador” toolkits in Spanish and English, with social media graphics and flyers geared toward families and older residents on how to set up an online account to re-enroll. Utah said it developed billboard and radio ads along with its own toolkits and flyers in 13 languages.
Still, grassroots groups say they are doing the heavy lifting.
These advocates’ outreach efforts go “beyond the walls of the capitol,” said Dr. Dena Hubbard, a neonatologist at Children’s Mercy hospital in Kansas City who chairs the public policy committee of the American Academy of Pediatrics’ Kansas chapter.
“(They’re) going to people, meeting people where they are in their communities, knowing what they need, knowing where they are, and helping them get the services they need,” she said. “I strongly feel that grassroots is where it’s at.”
‘Frustrated and nervous’
