As states cut Medicaid, consumers struggle for coverage

Many who were disenrolled still lacking

A 2-year-old girl with cystic fibrosis is among the masses of Americans who lost Medicaid coverage after the pandemic. The Jacksonville, Florida, toddler needed the insurance to cover lifesaving medication and doctor visits, according to a lawsuit brought by the girl’s mother and others. Instead, when she got sick last year, her family settled for a costly emergency room visit.

The crisis described by the Florida family is playing out in communities across the U.S. For millions of Americans, the nation’s pandemic-era expansion of Medicaid health insurance is coming to an end.

Some turned to options including an employer insurance plan or the Affordable Care Act. Others survived without insurance, avoided unaffordable doctor’s visits and left prescriptions unfilled.

A new survey on the fallout from resumed checks on Medicaid eligibility found that nearly 1 in 4 people bumped from Medicaid coverage last year remain uninsured. Nearly half the people kicked out of the program ultimately qualified again, suggesting they shouldn’t have been thrown out in the first place. And millions endured gaps in coverage that could have endangered their health.

The KFF survey found that 23% of Medicaid recipients disenrolled when states resumed eligibility checks last year still don’t have health insurance. These individuals are more likely to struggle to pay for health care and delay medical appointments.

KFF, a nonprofit health policy organization, designed the survey to discover how eligibility checks had impacted people on Medicaid, the federal health program for low-income people and people with disabilities.

The federal government provided billions of dollars in federal aid to states on the condition that they not remove people from Medicaid until the COVID-19 emergency was over. When the public health emergency ended and eligibility checks resumed last April, states were allowed to pursue these checks at their own pace. Some states accelerated checks while others took longer to implement them. Two states, Oregon and Alaska, won’t complete the checks until early 2025.

KFF’s national survey of more than 1,200 U.S. adults found 19% with Medicaid coverage during the pandemic were disenrolled – some temporarily and others for longer stretches.

Among the people removed from Medicaid, 47% said they eventually qualified again for Medicaid coverage. More than 1 in 4 adults secured health insurance from an employer, the military, an Affordable Care Act insurance plan or Medicare, the federal health program for people 65 and older.

Even before the pandemic began, people churned in and out of Medicaid as their life circumstances changed, such as getting hired, losing a job or having a child. What’s unique about the past year is the sheer number of eligibility checks state Medicaid programs confronted at once − a process referred to as unwinding − because the ranks of enrollees swelled during the COVID-19 public health emergency.

KFF’s research shows that 20.1 million Medicaid recipients were disenrolled since the eligibility checks resumed a year ago. Another 43.6 million people had their coverage renewed, and 30.4 million are awaiting Medicaid renewals.

Most states should be done with the renewals by June, said Jennifer Tolbert, deputy director of KFF’s program on Medicaid and the uninsured. She said the Centers for Medicare & Medicaid Services, the federal agency that oversees Medicaid, is expected to release an estimate on when states will complete these pandemic-era reviews soon.

Tolbert said it’s possible many people were mistakenly kicked off Medicaid. This would explain why so many people who were removed were soon added back to the public health insurance program. These removals had an impact, she said, because even temporarily losing coverage can harm people.

The survey found that 56% of people who lost Medicaid coverage had skipped or delayed medical care.

“This was a much bigger problem for people who were disenrolled (which) led to gaps in accessing needed care,” Tolbert said.

Dumped from Medicaid, Alabama woman turns to Obamacare

Alabama resident Kayla Wildman, 31, qualified for Medicaid coverage before she gave birth to her first son in December 2020. Wildman, who lives in a small town southeast of Huntsville, said the insurance was comprehensive and helped her pay for doctor’s appointments, medication and bills from the birth of her second child in 2022.

Last December, midway through a three-month treatment for hepatitis C, she was dropped from Alabama’s Medicaid program. Without insurance, she knew she knew she could not afford to pay thousands of dollars for the medication.

“I was freaking out, actually,” Wildman said. “I couldn’t afford to pay full price out of pocket. So I was like, ‘What do I do?’”

Before she was pregnant with her first child, Wildman had insurance through her job at a hospital. Before that, she tried to buy coverage through the Affordable Care Act, known as Obamacare, but the plans cost too much.

She tried again when she lost Medicaid last November and bought a Blue Cross Blue Shield plan through the ACA marketplace for $65 per month. The KFF survey found 8% of people like Wildman, who were removed from Medicaid, secured a new plan through the ACA, thanks in part to more generous pandemic-era subsidies that make the monthly premiums more affordable.

The insurance plan paid for her hepatitis C treatment, and she is now cured of the viral disease.

She also has a wider selection of doctors compared with her choices under Medicaid.

“It isn’t so unaffordable that I can’t manage it,” she said.

Consumer advocates challenge Medicaid cuts

Consumer advocates say many people have lost Medicaid coverage because of paperwork glitches and other administrative mistakes. The Medicaid renewals are perhaps the largest bureaucratic endeavor in government health insurance coverage since the Affordable Care Act launched state Medicaid expansions more than a decade ago.

Advocates say consumers have encountered long wait times when calling for help from state Medicaid programs. Other patients, including some people with disabilities, have had trouble getting in-person help, said Alicia Emanuel, a senior attorney with the National Health Law Program in Los Angeles.

People on Medicaid always faced these challenges, but the pandemic backlog of renewals magnified the issues, Emanuel said.

“These issues are illustrative of cracks in the Medicaid system,” Emanuel said. “These are issues that advocates have been sounding the alarm (about) for years. It’s just reached an inflection point because of the unwinding.”

Attorneys representing Medicaid enrollees in Tennessee and Florida have sued to challenge their states for denying coverage to adults and children. Both lawsuits are pending.

The Florida class-action lawsuit was brought by two mothers of two toddlers who said the state did not provide their families with proper written notification before terminating their coverage.

KFF’s Tolbert said disruptions in care are inevitable when such a large number of people nationwide must renew coverage. In many cases, people who get coverage through an employer or the ACA marketplace find out they’re expected to pay for a larger share of their health bills through deductibles and coinsurance.

“Many people moving from Medicaid to other coverage are expressing concerns about their ability to afford the cost of care under their new insurance,” Tolbert said.

A new survey on the fallout from resumed checks on Medicaid eligibility found that nearly 1 in 4 people bumped from Medicaid coverage last year remain uninsured. Nearly half the people kicked out of the program ultimately qualified again, suggesting they shouldn’t have been thrown out in the first place.