Hundreds of thousands of people 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 a sprawling unraveling of a pandemic-era policy that barred states from withdrawing people from the program.

Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients failed to return documents to verify their eligibility or could not be located. The large number of terminations for procedural reasons suggests that many people may lose their coverage even if they are still eligible. Many of those left behind were children.

From the start of the pandemic until this spring, states have not been allowed to deport people from Medicaid under a provision of a coronavirus relief package passed by Congress in 2020. The guarantee of continued coverage has spared people regular eligibility checks during the public health crisis and caused Medicaid enrollment to reach record highs.

But the policy expired at the end of March, triggering a massive bureaucratic undertaking across the country to check who remains eligible for cover. 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 denouement is taking on some of the poorest and most vulnerable Americans.

So far, at least 19 states have started removing people from the lists. A precise total of the number of people who have lost their coverage is not yet known.

In Arkansas, more than 1.1 million people — more than a third of state residents — were on Medicaid at the end of March. In April, the first month states were able to begin removing people from the program, about 73,000 people lost coverage, including about 27,000 children 17 and under.

Among those left behind was Melissa Buford, a diabetic with high blood pressure who earns about $35,000 a year at an eastern Arkansas health clinic to help families find affordable health insurance. Her 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 increased. A notice she received advising her that she was not eligible upset her so much that she threw it in a trash can.

But the majority of those who lost coverage in Arkansas were dropped for procedural reasons.

Daniel Tsai, a senior Centers for Medicare and Medicaid Services official who helps oversee the Biden administration’s unwinding process, said more outreach is needed to help those who lost coverage this way. He said federal officials were in regular contact with state officials across the country to review early data on the course and check whether people who lost coverage had a chance to prove their eligibility.

Gov. Sarah Huckabee Sanders of Arkansas, a Republican, called the rollout a necessary process that will save money and allow Medicaid to work as intended.

“We are simply removing ineligible participants from the program to reserve resources for those who need them and to comply with the law,” Sanders wrote in an op-ed in The Wall Street Journal this month. She added that “some Democrats and activist journalists oppose Arkansas’ 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 component of the American safety net. At the start 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 happened in Arkansas so far offers evidence of the widespread disruption the unwinding process is likely to cause in households across the country over the coming months, forcing Americans to find new insurance or find out how to recover the Medicaid coverage they lost due to procedural reasons. The federal government has projected around 15 million people will lose coverage, including nearly seven million people who are expected to be dropped despite still being eligible.

One of the biggest questions is how the process will affect children. In Florida, for example, a boy in remission from leukemia and requiring a biopsy recently lost his coverage.

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

“These children have nowhere to turn for coverage,” she said. “Medicaid is the largest insurer for children. It is extremely important for them.

In Arkansas, many children who lost Medicaid were “the poorest of the poor,” said Loretta Alexander, director of health policy for Arkansas Advocates for Children and Families. She added that the loss of coverage would be particularly harmful for young children who need regular developmental checks early in life.

Most states take about a year to complete, 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 the children’s eligibility for Medicaid coverage early in the process because they make up a substantial portion of those enrolled, according to Gavin Lesnick, spokesman for the state Department of Human Services. .

In her op-ed, Ms. Sanders pointed to the campaign the state has been running to alert residents to the unfolding, called Renew Arkansas.

“We have hired additional staff and recruited volunteers to help us,” she wrote. “We’ve been texting, emailing, and calling tens of thousands of Arkansans who are likely no longer eligible for Medicaid, and we’ve made a special effort to reach people with disabilities, those who have moved away, those suffering conditions such as cancer, those receiving dialysis and pregnant women.

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

Other states have also removed large numbers of Medicaid beneficiaries for procedural reasons. In Indiana, nearly 90% of the approximately 53,000 people who lost Medicaid in the first month of the dismantling of the state were deported on these grounds. In Florida, where nearly 250,000 people lost their Medicaid coverage, procedural reasons were to blame for the vast majority.

In addition to taking different approaches to removing people from Medicaid, states also publish data on their progress in different ways, making it difficult to compare their strategies in the early stages of unwinding. “We compare apples to oranges to tangerines,” Ms. Alker said.

Some people who lose Medicaid coverage are expected to obtain health insurance through their employer. Others are likely to look to Affordable Care Act markets for private insurance, and many will be eligible for premium-free plans.

Debra Miller, 54, of Bullhead City, Arizona, lost her Medicaid coverage in April after her annual salary of around $25,000 as a cook at Burger King left her ineligible. Ms Miller, a single mother with diabetes and hypothyroidism, worked with an insurance advisor at North Country HealthCare, a network of federally funded health clinics, to enroll in a market plan with a premium monthly about $70.

“It’s a struggle because it’s a new bill that I’ve never had before,” she said. Her new plan, she added, does not include vision insurance, which leaves her worried about paying for the eye appointments she needs as a diabetic.

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

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

Ms Buford said her work helping others find health insurance in underserved areas was a vocation inspired by watching her grandmother struggle to pay for her medicine and rely on pantries. Ms Buford went to 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’m able to help people,” she says.

Now that she has lost her Medicaid coverage, Ms. Buford said she hopes to find an affordable market plan in the near future. The family plan offered by the clinic where she works is too expensive, she says.

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