Medicaid Disenrollment After the COVID-19 Pandemic

Abstract

Enrollment in the Medicaid program has swelled to nearly 83 million people since the onset of the COVID-19 pandemic. 1 This growth-an increase of approximately 17%-has been attributed to new enrollment of those experiencing pandemic-induced job losses and the continuous coverage provisions of the federally declared Public Health Emergency (PHE), which prohibits state Medicaid agencies from terminating coverage for most beneficiaries. With the provisions set to expire, it is projected that millions of beneficiaries may lose their coverage as states resume regular redeterminations of eligibility. In the absence of proactive measures from states and the federal government, access to care may be compromised for a broad swath of the US population, potentially compounding inequities laid bare by the COVID-19 pandemic.Under the Families First Coronavirus Recovery Act (FFCRA) 2 passed in March 2020, states can qualify for a higher federal share of Medicaid costs during the PHE if they adhere to new maintenance of eligibility requirements that prohibit termination of coverage (all states have complied). As a result, while newly eligible beneficiaries were required to certify income and asset levels to enroll in the program, existing beneficiaries were exempt from the typical redetermination process. Before

Medicaid and the Children’s Health Insurance Program: an overview for the pediatric radiologist

“…Those who failed to meet requirements, for instance due to income fluctuations, lost coverage, with many then re-applying when circumstances changed. This constant exiting and re-entering Medicaid, known as “churning,” is associated with health care access challenges and poor health outcomes [ 64 – 66 ]. An estimated 25% of Medicaid beneficiaries change coverage each year, resulting in gaps in health care coverage [ 67 ].…”

“…The continuous coverage requirement limited states from conducting redeterminations and disenrolling individuals, regardless of their eligibility status during the public health emergency [ 64 – 66 , 70 ]. This protected many from inappropriate disenrollment.…”

A conceptual model of health insurance stability in the United States health care system

“…Income changes over time cause “churning,” or insurance instability from transitions in-and-out of Medicaid or between Medicaid and private insurance offered through insurance exchanges or an employer. 63,64 For gender , women with private insurance were less likely to lose coverage than men, but women with public coverage were more likely to lose and regain coverage. 6 Race/ethnicity could also play a role; coverage varies by racial/ethnic group, with Whites most likely to have coverage (95%) and have private coverage (75%) and Hispanics least likely (82% and 50%), respectively.…”

Variation in Procedural Denials of Medicaid Eligibility Across States Before the COVID-19 Pandemic

“…Medicaid enrollment exceeded 93 million people during the COVID-19 pandemic, largely due to the Families First Coronavirus Response Act, which incentivized states to pause redeterminations of Medicaid eligibility. [1][2][3] In April 2023, states could resume redeterminations, with estimates suggesting 17.4% of enrollees are at risk of losing coverage. 4 Millions are projected to lose coverage for solely procedural reasons (eg, after missing a required renewal form following a change in address) despite remaining eligible.…”

“…Medicaid enrollment exceeded 93 million people during the COVID-19 pandemic, largely due to the Families First Coronavirus Response Act, which incentivized states to pause redeterminations of Medicaid eligibility . In April 2023, states could resume redeterminations, with estimates suggesting 17.4% of enrollees are at risk of losing coverage .…”