Biden administration slow to act as millions booted off Medicaid
WASHINGTON — Up to 30 million of the poorest Americans could be purged from the Medicaid program, many the result of error-ridden state reviews that poverty experts say the Biden administration is not doing enough to stop.
The projections from the health consulting firm Avalere come as states undertake a sweeping reevaluation of the 94 million people enrolled in Medicaid, government's health insurance for the neediest Americans. A host of problems have surfaced across the country, including hourslong phone wait times in Florida, confusing government forms in Arkansas, and children wrongly dropped from coverage in Texas.
“Those people were destined to fail,” said Trevor Hawkins, an attorney for Legal Aid of Arkansas.
Hawkins helped hundreds of people navigate their Medicaid eligibility in Arkansas, as state officials worked to “swiftly disenroll” about 420,000 people in six months' time. He raised problems with Arkansas' process — like forms that wrongly told people they needed to reapply for Medicaid, instead of simply renew it — with the Centers for Medicare and Medicaid Services.
Nothing changed, he said.
“They ask questions but they don't tell us what is going on,” Hawkins said of CMS. “Those should be major red flags. If there was a situation where CMS was to step in, it would have been Arkansas.”
Nearly a dozen advocates around the country detailed widespread problems they've encountered while helping some of the estimated 10 million people who've already been dropped from Medicaid. Some fear systemic problems are being ignored.
Congress ended a COVID-19 policy last year that barred states from kicking anyone off Medicaid during the pandemic, requiring them to undertake a review of every enrollee's eligibility over the next year. But the Democratic-led Congress also gave Health and Human Services Secretary Xavier Becerra the power to fine states or halt disenrollments if people were improperly being removed. HHS has shared little about problems it has uncovered.
Earlier this year, the agency briefly paused disenrollments in 14 states, but it did not disclose which states were paused or for what reasons.
In August, HHS announced thousands of children had been wrongly removed in 29 states that were automatically removing entire households, instead of individuals, from coverage. CMS required the states to reinstate coverage for those who had been terminated under that process, said Daniel Tsai, the director of the CMS Center for Medicaid and Children's Health Insurance Program Services.
“We are using every lever that we have to hold states accountable,” Tsai said.
Florida tried twice to remove Lily Mezquita, a 31year-old working mom in Miami, from Medicaid during her pregnancy this year. She pleaded her case in 17 phone calls — some with wait times stretching as long as two hours — before she was finally reinstated in August from her hospital bed while in preterm labor. Mezquita would explain the state's law, which says she's guaranteed coverage through her pregnancy and 12 months after giving birth.
If trends continue, as many as 30 million people could end up being dropped from Medicaid at some point once states finish reviewing their Medicaid rolls, according to Avalere's projections. The numbers dwarf the Biden administration's initial projections that only 15 million people would lose coverage throughout the process.
“We have to say it's going poorly,” Massey Whorley, a principal at Avalere, said of the Medicaid redeterminations. “This has been characterized by much higher-than-expected disenrollment.”
Most have been removed for procedural reasons, like failing to send back their renewal form or mail in proper paperwork. That points to bigger problems with how the states are determining Medicaid eligibility: Their notices aren't reaching people, don't make sense or they're requiring unnecessary paperwork. Many of the people removed for those reasons may still qualify for Medicaid and might eventually be re-enrolled.