I’m referring to the big Medicaid purge, which could happen as early as this summer.
In “normal” non-pandemic years, many people move in and out of public health coverage. This could be due to changes in their income, age or disability status.
However, people also lose coverage because constantly proving and re-proving their eligibility is onerous, especially if you’re poor, not particularly adept at navigating red tape, or don’t have stable housing.
In many states, failing to respond to an official letter that, for example, was sent to the wrong address can lead an otherwise eligible family to getting kicked off Medicaid rolls.
Losing insurance is painful even in normal times. But losing it during a public health crisis is arguably worse. And so, after ignoring the issue of administrative rotation for decades, Congress finally did something about it when covid hit.
In March 2020, lawmakers decided to keep as many people insured as possible, at least temporarily. They increased federal funding matching for Medicaid spending and required states that received that money to guarantee “continuous coverage” to Medicaid enrollees. In other words, states had to promise not to kick people out of their coverage for a certain period of time.
The plan worked – surprisingly well.
Between February 2020 and last fall, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by about 13.6 million people, or 19%, according to the Kaiser Family Foundation. Today, half of children nationwide are covered by Medicaid or CHIP, a record, says Joan Alker, executive director of the Georgetown University Health Policy Institute Center for Children and Families.
These increases are partly due to loss of income, making people newly eligible for Medicaid and partly because of these temporary opt-out freezes.
But this freeze and additional funding is tied to the duration of the covid “public health emergency”. The administration decides on the duration of this “emergency”. He recently announcement that the designation would continue at least until half April, but beyond that things are uncertain. Other communications from the administration suggest the emergency measures could end as early as this summer.
So the question becomes: how many people are being purged? And how will the purged find other affordable sources of insurance, especially when the health-related measures proposed in the Democrats’ Build Back Better package appear to be dead?
Early counts of likely Medicaid coverage losses are staggering. In Utah, roughly 120,000 peoplehalf of which are children, could be thrown rolls — largely due to incomplete renewal documents and poor record keeping. One of Utah’s leading Medicaid managed care plans recently told state officials it could not reach 40 percent of its members because it does not have correct addresses or telephone numbers.
The numbers are even higher in other states. Arizona recently said 500,000 people are at risk of losing Medicaid for similar reasons. There are another 500,000 in Colorado. And 500,000 more in Pennsylvania.
A recent report of the Georgetown University Health Policy Institute Center for Children and Families estimates that at least 6.7 million children alone are at risk of losing Medicaid coverage nationwide and are at “significant risk of being uninsured for a time”.
For context, in 2019 – the last pre-pandemic year – 4.4 million children total were not insured.
Some of these children would be eligible to enroll in other insurance plans – such as CHIP, their parents’ employers or the individual market – but many risk losing their coverage during the transition. Switching from one plane to another is not exactly seamless. Other children may remain eligible for Medicaid but still lose coverage due to these tedious procedural issues. Children in Delaware, Florida, Georgia, Missouri, Nevada and Texas are at particular risk of becoming uninsured, the Georgetown researchers found, due to the operation of public insurance programs in those states ( more frequent reverification documents, for example).
While some states anticipate these issues and attempt to warn families that they may soon lose coverage, many public health departments are understaffed and do not practice this type of outreach.
States could incorporate their experiences from the past two years and reduce some red tape or relax eligibility requirements to make it easier for families to maintain coverage. Some however, whether for ideological reasons or budgetary pressures. Some conservative groups are already pressuring governors to start the purge process.
For all the ills covid has wrought, the pandemic has also prompted politicians to tackle a host of pre-public health crisis issues. The expansion of the child tax credit, for example, lifted millions of people out of poverty. However, as infections recede, these emergency programs also disappear, while the underlying problems persist. We are all eager to get back to ‘normal’, but for poor families who depend on an unreliable safety net, ‘normal’ has never been enough.