Millions of Americans lose Medicaid coverage as pandemic-era policies end

Read the Full Transcript

• Geoff Bennett:

  Medicaid recipients have typically had to prove their eligibility each year to renew their coverage. But that stopped during the onset of the COVID pandemic.

  And, for three years, recipients have been continuously enrolled. But that re enrollment provision ended in April. And, since then, more than 15 million people have been disenrolled from Medicaid.

  We're joined now by Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF.

  Thank you for being with us.

  So, Jennifer, what accounts for the 15 million disenrollments? Are people forgetting to reenroll or is something else at play?

  Jennifer Tolbert, Deputy Director, Program on Medicaid and the Uninsured, KFF: Well, I think it's a combination of factors.

  So, because states kept people on the Medicaid program for three years during the pandemic, there are a number of people who have had changes in circumstances, they have gotten new jobs, they have increased their hours at their existing jobs, and because of that increase in income, are no longer eligible.

  But we also know that there are a lot of people who are losing coverage for what are called procedural or paperwork reasons. And this is a situation in which the state is disenrolling someone, even though they don't have information to confirm whether the person is still eligible.

• Geoff Bennett:

  And who is most affected by that? And what about children who are covered by Medicaid? How are they affected?

• Jennifer Tolbert:

  Yes, we're seeing a lot of disenrollments among children.

  I think going into this process, the assumption was because Medicaid eligibility for children is higher than that for adults, that there would be fewer disenrollments among children. But among reporting states, and we only have data from about 23 states, but among those states showing disenrollments broken out by age, children account for nearly 40 percent of all disenrollments.

  And so, nationally, that translates to about five million children losing coverage.

• Geoff Bennett:

  And when people lose coverage, what exactly are they losing? What's at stake here?

• Jennifer Tolbert:

  Yes, well, they're losing their access to medical care. And many people on Medicaid are dealing with chronic health conditions or mental health issues for which they need ongoing medication and treatment.

  And particularly for kids, this can mean losing access to needed medications to control ADHD or to help with autism or diabetes. And so losing Medicaid coverage, even if it may be for a short period while someone is trying to get reenrolled, can lead to lapses in care, so people not being able to get needed medications, not being able to see doctors or therapists that can help them control whatever health care issue they're dealing with.

• Geoff Bennett:

  You know, looking at the numbers, there is a wide range of disenrollment rates across the country, 61 percent in Texas to 13 percent in Maine and Oregon. Why is that?

• Jennifer Tolbert:

  Yes, there are a lot of different factors at play here.

  Some of it has to do with when states started disenrolling people. Some states started earlier than others. Other states have taken greater steps to try and ensure that people who are still eligible remain on the program. So one thing that states are doing or required to do, in fact, is to conduct what are called ex parte reviews.

  And this is where state checks available data sources to see if an individual continues to qualify for Medicaid before they send a renewal notice asking someone to complete forms and provide other documentation. States that have higher ex parte renewal rates tend to have lower disenrollment rates, because they are able to enroll or renew more people without asking people to take action, which can be burdensome, or which can lead to problems like people not receiving notices in the mail or not being able to gather the required documents that the state is requesting.

• Geoff Bennett:

  If someone believes that they have been improperly disenrolled, what can they do?

• Jennifer Tolbert:

  Yes.

  So the best thing to do is to contact the Medicaid agency as quickly as possible. Now, unfortunately, this can be difficult in many states because there are still long wait times for many call centers when people try and get through.

  But my advice is to stay patient and continue to try and get through to the Medicaid agency. If not that, there are community-based organizations and entities called navigators and enrollment assisters that can provide people with help to complete their renewal process or to challenge if they think they have been improperly disenrolled.

• Geoff Bennett:

  Jennifer Tolbert with KFF, thanks so much for your insights. We appreciate it.

• Jennifer Tolbert:

  Thank you.