Pandemic saw surge in CT Medicaid enrollment
There are just shy of 1 million people on Medicaid in Connecticut, 120,000 more than there were at the start of the pandemic, according to data obtained by Hearst Connecticut Media.
The sheer numbers of Connecticut residents on Medicaid has raised questions for advocates about how those people will transition into other health care coverage, and concerns that communities of color will be disproportionately affected.
“Structural racism has created a set of circumstances that make it far more likely for Connecticut’s Black, Latino, indigenous and other residents of color to lose health coverage when the public health emergency ends,” said Karen Siegel, director of policy for Health Equity Solutions.
In total, more than 955,489 people in Connecticut are using Medicaid coverage as of May, the last month for which data is available. That’s an increase of 127,523 from January 2020, when 827,966 people in Connecticut were on Medicaid.
The spike in Medicaid coverage, according to state Department of Social Services spokesman David Dearborn, is a result of pandemic- related job loss, and the “maintenance of eligibility” requirements of the federal Families First Coronavirus Response Act.
“The main reason for the overall increase in enrollment is that people generally aren’t being discontinued from Medicaid coverage once they are enrolled,” Dearborn said.
Generally, parents qualify for Medicaid coverage if they are 160 percent or below the federal poverty level. Single adults qualify for Medicaid if they are 133 percent below the federal poverty level.
“Many people have fluctuating incomes and life situations — if they qualified for Medicaid at any point since March 2020 they’ve been kept on,”
Dearborn said. “This illustrates the constantly changing nature of eligibility — people age into different coverage groups, children get older, incomes change. Connecticut has largely disregarded all those changes and has kept people enrolled.”
The federal public health emergency declaration officially ends July 19, but Siegel said the Biden administration has signaled that it will be renewed through the end of the year
When the federal public health emergency declaration ends, thousands of Connecticut residents may no longer qualify for Medicaid coverage. It’s not just those who may have had what Siegel called “the good fortune of finding a better job during COVID or a higher paying job.”
If people enrolled in Medicaid coverage don’t respond to renewal notices, perhaps because their living situation changed, they could lose coverage as well.
“I have significant concerns about what happens when the emergency ends and what the department is doing now to be prepared,” Siegel said. “I do think that there’s a significant risk of uninsurance going up when the public health emergency ends.”
There is, according to Tiffany Donelson, a “natural rise and fall of people on Medicaid.”
“Every year Medicaid has to redetermine who can stay on Medicaid and who doesn’t, said Donelson, president and CEO of the Connecticut Health Foundation. “The way that the public health emergency has worked in the federal government, they are not allowing states to terminate any coverage through that redetermination process.”
Like Siegel, Donelson said “sometimes the coverage is lost because of employment, or because people have issues with the redetermination process.”
Though they provided context and data to Hearst Connecticut Media, state Department of Social Services officials did not say what that redetermination process was going to look like.
According to Donelson, “the state is aware that the redetermination process is going to have to happen again as it has in the past,” and that “they are doing their best to assure that the process goes as smoothly as possible for people.”
Donelson and Siegel expressed concerns that the redetermination process would negatively impact communities of color and urban neighborhoods, which bore the brunt of both pandemic- related job loss and illness.
“Disproportionately, it is communities of color who are uninsured or underinsured in our state consistently,” Donelson said.
Stakeholders are “thinking about ways to mitigate some of the inequities,” Donelson said, though “typically, when there are imperfections in any of these processes, it disproportionately impacts people of color and low income individuals in our state.”
“I know that folks who are working on this are thinking about how to handle it in an equitable way,” she said. “Now, is it a perfect process? Will it work perfectly? I don’t know. I can’t give you a guarantee about that.”
Another question is what health care coverage residents will be able to afford when they no longer qualify for Medicaid. There are subsidized health care plans offered under Access Health CT, and the state is implementing plans to offer subsidies for people at 175 percent of the federal poverty level, but some residents can’t afford even modest coverage, Donelson said.
Her organization works with residents at 200 percent of the federal poverty level, who she said “can’t afford even the $ 20 a month for coverage.”
“We’re in an emergency state, but we also have to think about how some of these folks were in an emergency state, even before the pandemic,” she said.
Of course, more people may be eligible for company- subsidized health insurance or afford more coverage as the economy improves and more jobs are created. The Bureau of Labor Statistics said Wednesday that “unemployment rates were lower in May than a year earlier in all 389 metropolitan areas.”
“The other piece is the hope is that we regain some employment and so that people will be able to get back on employersponsored coverage as we recover,” Donelson said. “So that is really a big piece of it.”