Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of an expansion of a pandemic-era policy that barred states from removing people from the program.
Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients did not return paperwork to verify their eligibility or could not be traced. The large number of terminations on procedural grounds suggests that many people are losing their coverage, even though they still qualify for it. Many of those released are children.
From the start of the pandemic until this spring, states were barred from kicking people out of Medicaid under a provision of a coronavirus relief package passed by Congress in 2020. The guarantee of continued coverage steered people away from routine eligibility screenings during the public health crisis and enrollment in Medicaid to surge to record levels.
But the policy expired in late March, triggering a massive bureaucratic undertaking across the country to verify who is eligible for coverage. In recent weeks, states have begun releasing data on who has lost coverage and why, offering the first glimpse of the punishing toll that so-called unwinding is taking on some of the poorest and most vulnerable Americans.
So far, at least 19 states have started removing people from the rolls. The exact total of how many people have lost coverage is not yet known.
In Arkansas, more than 1.1 million people — more than a third of the state’s residents — were on Medicaid at the end of March. In April, the first month when states could begin removing people from the program, about 73,000 people lost coverage, including about 27,000 children 17 and under.
Among those laid off was Melissa Buford, a diabetic with high blood pressure who makes about $35,000 a year at a health clinic in eastern Arkansas helping families find affordable health insurance. His two adult sons also lost their coverage.
Like more than 5,000 others in the state, Ms. Buford, 51, was no longer eligible for Medicaid because her income had gone up. A notice informing him that he was not eligible upset him so much that he threw it in the dustbin.
But most of those who lost coverage in Arkansas were dropped for procedural reasons.
Daniel Tsai, a senior official at the Centers for Medicare and Medicaid Services who is helping oversee the reluctance process for the Biden administration, said more outreach was needed to help those who lost coverage in this way. He said federal officials were in regular contact with state officials around the country to review early data on unwinding and to check that those who have lost coverage are being treated appropriately to prove their eligibility. shot or not.
Sarah Huckabee Sanders of Arkansas, a Republican, has framed the unwinding as a necessary process that will save money and allow Medicaid to function within its intended scope.
“We are only removing ineligible participants from the program who need the resources and to comply with the law,” Ms Sanders wrote in an opinion essay in The Wall Street Journal this month. He added that “some Democrats and activist reporters oppose Arkansas’ actions because they want to keep people dependent on the government.”
Medicaid, which is funded jointly by the federal government and the states, has become an increasingly far-reaching component of the American safety net. Earlier this year, 93 million people — more than one in four Americans — were enrolled in Medicaid or the children’s health insurance program, up from 71 million before the pandemic.
What’s played out so far in Arkansas offers evidence of the widespread disruption that the unwanted process is likely to cause in homes across the country in the coming months, forcing Americans to find new insurance or figure out where to go. How to regain Medicaid coverage they lost for procedural reasons. The federal government has estimated that about 15 million people will lose coverage, including about seven million who are expected to be dropped while still eligible.
The biggest looming question is what effect this process will have on the children. For example, in Florida, a boy in remission from leukemia who needed a biopsy recently lost his coverage.
Researchers at the Georgetown University Center for Children and Families estimated before Unending that more than half of children in the United States were covered by Medicaid or CHIP. Many children who lose coverage will be turned away for procedural reasons even though they are still eligible, said Joan Alcar, the center’s executive director.
“Those kids have nowhere else to turn for coverage,” she said. “Medicaid is the biggest insurer for kids. It’s hugely consequential for them.
In Arkansas, many of the children who lost Medicaid were “the poorest of the poor,” said Loretta Alexander, health policy director for Arkansas Advocates for Children and Families. He said losing coverage would be especially harmful to young children, who need regular developmental screenings early in life.
Unwinding is taking about a year to complete, with most states using their own approaches to removing people from Medicaid. But in Arkansas, legislation passed in 2021 required state officials to complete the process in just six months. State officials screen children with Medicaid coverage early in the eligibility process because they make up a large portion of those enrolled, according to Gavin Lesnick, a spokesman for the state Department of Human Services.
In her opinion essay, Ms. Sanders pointed to a campaign the state has waged to alert residents to the unwinding called Renew Arkansas.
“We have hired additional staff and enlisted volunteers to help,” she wrote. “We texted, emailed and called thousands of Arkansans who are now ineligible for Medicaid, and we made a special effort to reach people with disabilities who have moved, who are suffering from ailments like cancer, who are on dialysis. are receiving and women who are pregnant.
Local health workers like Ms. Buford are trying to help people get coverage again if they still qualify for it. She said she had worked with 50 to 75 Medicaid recipients who lost coverage in April, helping them fill out forms or answering their questions about verifying their eligibility.
Other states have also removed large numbers of Medicaid recipients for procedural reasons. In Indiana, about 90 percent of the nearly 53,000 people who lost Medicaid in the first month after the state capitulated were booted on those grounds. In Florida, where nearly 250,000 people lost Medicaid coverage, procedural reasons were blamed for a vast majority.
In addition to taking different approaches to weaning people off Medicaid, states are also releasing data about their progress in different ways, making it difficult to compare their strategies in the early stages of unwinding. “We are comparing apples to oranges to tangerines,” Ms. Elker said.
Some people who lose Medicaid coverage are expected to obtain health insurance through their employer. Others are likely to turn to the Affordable Care Act’s marketplace to sign up for private insurance, and many of them will be eligible for no-premium plans.
Debra Miller, 54, of Bullhead City, Ariz., lost Medicaid coverage in April after her roughly $25,000 annual salary as a Burger King cook made her ineligible. Ms. Miller, a single mother with diabetes and hypothyroidism, works with an insurance counselor at North Country Healthcare, a network of federally funded health clinics, to enroll in a marketplace plan with a monthly premium of about $70 Is.
“It’s a struggle because it’s a new bill that I didn’t have before,” she said. She said her new plan doesn’t include vision insurance, which worries her about paying for eye appointments as a diabetic.
Ms. Buford said Marketplace coverage would be too expensive for some people in Arkansas.
“You have a car, mortgage, kids, food,” she said. “You don’t really have that much left over to pay for health insurance that much.”
Ms. Buford said her work to help others find health insurance in underserved areas was inspired by watching her grandmother struggle to buy her medicines and rely on food pantries. Ms. Buford went to a community college near her hometown so she could care for her ailing father, who died at age 40. “I love my job because I am able to help people,” she said.
Now that she’s lost her Medicaid coverage, Ms. Buford said she hopes to find an affordable marketplace plan in the near future. She said that the family plan offered by the clinic where she works is very expensive.
“I am grateful for what I have because no one else has what I have,” Ms. Buford said. “I wish I could keep my Medicaid.”