Hundreds of thousands have lost their Medicaid coverage since pandemic protections expired

Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of an extensive winding down of pandemic-era policies that banned states from removing people from the program.

Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients failed to return paperwork verifying eligibility or could not be located. The high number of cancellations on procedural grounds suggests that many people may lose their coverage while still being eligible. Many of those who have been dropped have been children.

From the start of the pandemic until this spring, states were prohibited from kicking people off Medicaid under a provision in a coronavirus relief package passed by Congress in 2020. enrollment in Medicaid to soar to record levels.

But the policy expired at the end of March, sparking a massive bureaucratic effort across the country to verify who remains eligible for coverage. In recent weeks, states have begun releasing data on who lost coverage and why, offering a first glimpse of the punitive toll the so-called dissolution takes on some of the poorest and most vulnerable Americans.

At least until now 19 states have started removing people from the roles. An 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 using Medicaid at the end of March. In April, the first month states could start removing people from the program, approx 73,000 people lost coverageincluding about 27,000 children age 17 and under.

Among those dropped was Melissa Buford, a high blood pressure diabetic who earns about $35,000 a year at a health clinic in eastern Arkansas helping families find affordable health insurance. Her two adult sons also lost their cover.

Like more than 5,000 others in the state, Ms. Buford, 51, was no longer eligible for Medicaid because her income had increased. A message she received that she was not eligible upset her so much that she threw it in a trash can.

But a majority 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 helps oversee the settlement process for the Biden administration, said more help was needed to help those who lost coverage that way. He said federal officials were in regular contact with state officials across the country to review early settlement data and verify that people who lost coverage had a fair chance to prove eligibility.

Arkansas Governor Sarah Huckabee Sanders, a Republican, has presented the resolution as a necessary process that will save money and allow Medicaid to operate within its intended scope.

“We are simply removing ineligible participants from the program to reserve resources for those who need them and follow the law,” Ms Sanders wrote in a statement. opinion piece in The Wall Street Journal this month. She added that “some Democrats and activist reporters are resisting Arkansas’s actions because they want to keep people dependent on the government.”

Medicaid, funded jointly by the federal government and the states, has become an increasingly important part of the US safety net. At the beginning of 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 has played out in Arkansas so far provides evidence of the widespread disruption the settlement process is likely to cause in households across the country in the coming months, forcing Americans to look for new insurance or figure out how to manage Medicaid. recover coverage they lost for procedural reasons. The federal government has predicted that about 15 million people will lose coverageincluding nearly seven million people who are expected to be dropped despite still being eligible.

One of the biggest looming questions is how the process will affect children. For example, in Florida, a boy in remission from leukemia and who needs a biopsy recently lost its cover.

Researchers at the Georgetown University Center for Children and Families estimate that before completion more than half of the children in the United States were covered by Medicaid or CHIP. Many children who lose coverage will be dropped for procedural reasons, even though they are still eligible, said Joan Alker, the center’s executive director.

“Those kids have nowhere else to go for coverage,” she said. Medicaid is the largest insurer for children. This is very drastic 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. She added that losing coverage would be especially detrimental to young children who need regular developmental checkups early in life.

Most states take about a year to complete the phase-out, with each using its own approach 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 checked children’s eligibility for Medicaid coverage early in the process because they make up a significant portion of those enrolled, according to Gavin Lesnick, a spokesman for the State Department of Human Services.

In her op-ed, Ms. Sanders pointed to the campaign the state has been running to warn residents about the easing, called Arkansas refresh.

“We have hired additional staff and enlisted volunteers to help,” she wrote. “We have texted, emailed and called tens of thousands of Arkansans who are now unlikely to qualify for Medicaid, and we have made a special effort to help people with disabilities, people who have moved, people with conditions like cancer, people on dialysis and women who are pregnant.”

Local health workers like Ms. Buford are trying to help people get coverage again if they still qualify. She said she had worked with 50 to 75 Medicaid recipients who lost their coverage in April, helping them fill out forms or answering their questions about how to verify eligibility.

Other states have also removed large numbers of Medicaid recipients for procedural reasons. In Indiana, nearly 90 percent of about 53,000 people those that lost Medicaid in the first month of the state’s dissolution were booted on those grounds. In Florida, where nearly 250,000 people lost Medicaid coverage, procedural reasons were to blame for a vast majority.

In addition to different approaches to removing people from Medicaid, states also release data about their progress in different ways, making it difficult to compare their strategies in the early stages of tapering. “We’re comparing apples to oranges to tangerines,” Ms. Alker said.

Some people who lose Medicaid coverage are expected to purchase health insurance through their employer. Others will likely turn to Affordable Care Act marketplaces to sign up for private insurance, and many of them will qualify 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 chef made her ineligible. Ms. Miller, a single mother with diabetes and hypothyroidism, worked with an insurance consultant at North Country HealthCare, a network of publicly funded health clinics, to sign up for a marketplace plan with a monthly premium of about $70.

“It’s a struggle because it’s a new bill I haven’t had before,” she said. Her new plan, she added, doesn’t include vision insurance, which has her worried about paying for eye appointments she needs as a diabetic.

Ms. Buford said market coverage would be too expensive for some people in Arkansas.

“You have a car, mortgage, kids, food,” she said. “You really don’t have much left to pay so much for health insurance.”

Ms. Buford said her job helping others find health insurance in underserved areas was a calling inspired by watching her grandmother struggle to pay for her medications and rely on food supplies. Mrs. Buford attended a community college near her hometown so she could care for her ailing father, who died in his 40s. “I love my job because I can 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. The family plan offered by the clinic where she works is too expensive, she said.

“I’m thankful for what I have because someone else doesn’t have what I have,” said Ms. Buford. “I wish I could have kept my Medicaid.”