Approaching ‘Medicaid cliff’ could leave hundreds of thousands uninsured

SPRINGFIELD — As many as 700,000 Illinoisans may stand to lose their Medicaid coverage after March 31, but the Department of Healthcare and Family Services says it is working to reduce that number and help those affected find health insurance elsewhere.

Medicaid is a health insurance program for poor and disabled people that is jointly funded by the federal government and the states.

The coverage "cliff," as some have called it, is the result of a spending bill that Congress passed in December. It puts an end to a pandemic-era rule that sent billions of additional federal dollars to states if they agreed to keep Medicaid patients continuously enrolled in the program through the end of the public health emergency without having to go through the normal reapplication process.

Because that law separated the Medicaid rules from other emergency actions, the program will end sooner than the May 11 date on which both the White House and Gov. J.B. Pritzker plan to end their emergency declarations.

The change means many who have been receiving continuous Medicaid coverage throughout the pandemic will have to reapply for benefits, potentially leading to loss of coverage if the individual would no longer qualify for benefits or if they fail to complete a reapplication.

Nationwide, the federal government estimates that 15 million people, or 17.4% of Medicaid and Children's Health Insurance Program enrollees, will lose their coverage as a result of ending the continuous enrollment program. That would translate to roughly 700,000 people in Illinois if it follows the national pattern, but DHFS officials believe they can mitigate the impact of the rule change.

"At the state level, we estimate a total of roughly 384,000 will lose coverage because we believe in doing everything we can to help eligible Medicaid customers keep their benefits," DHFS spokesperson Jamie Munks said in an email. "The truth is, nobody knows for sure. What we do know is that we are committed to ensuring everyone who is eligible maintains their coverage, and that those who are not are given information about alternative coverage."

To avoid losing coverage, DHFS strongly urges Medicaid enrollees to fill out their renewal forms as soon as possible. The agency will resume regular verifications starting in late April, and people with a June renewal date will be the first ones to go through the restarted process. Those people will need to submit their renewal forms before June 1 so they can maintain coverage without disruption.

Munks said Illinois has been preparing for the eventual end of continuous coverage for months and has been communicating with Medicaid beneficiaries about the importance of updating their contact information on file with the Medicaid program.

"The state has and continues to increase customer service staff and enhance our systems," she said.

Munks said customers can complete their renewal by phone, although online is the preferred method.

The agency will try to reach affected individuals by mail, email, text messaging, phone calls and paid advertising, she said. It will also work with partner providers, advocacy organizations, nonprofits and other government entities, she added.

Munks said people who are found to be ineligible may still have other options for low-cost insurance, including individual plans sold through the Affordable Care Act marketplace, which operates in Illinois under the name Get Covered Illinois. People who meet certain income guidelines can receive tax credits to pay all or part of their premiums.

Who is most affected?

Throughout the pandemic, people who were enrolled in Medicaid did not have to go through the normal process of reapplying every 12 months to determine whether they were eligible, even if there were changes in their income or household that would normally make them ineligible.

DHFS says that Illinois' Medicaid enrollment grew by about 1 million enrollees during that period, to 3.9 million. But the state also received an additional $3 billion in federal funding through the enhanced matching rate.

The U.S. Department of Health and Human Services estimates that when the continuous enrollment program ends, about 9.5% of Medicaid enrollees nationwide, or 8.2 million people, will lose coverage because they are no longer eligible. The most common reasons for losing eligibility are changes in income or household makeup or moving out of the state in which they were covered.

But another 7.9%, or 6.8 million people, will lose coverage despite still being eligible for Medicaid because they don't complete their applications properly or the state is somehow unable to process the application — a process called "administrative churning."

Children and young adults, ages 18-34, make up the largest categories of people expected to lose coverage. The change is also expected to disproportionately affect the Latino community, which makes up one quarter of those predicted to be ineligible and one-third of those expected to experience churning.

Black individuals make up 14% of those expected to lose Medicaid eligibility and 15% of those expected to experience churning.