Medicaid cuts prove burden for many

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.

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 remains 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 in April 2023, 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 that 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, for example after 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 20.1million Medicaid recipients were disenrolled since the eligibility checks resumed. Another 43.6million people had their coverage renewed, and 30.4million 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 federal Centers for Medicare & Medicaid Services 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 had been 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.

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 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 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 local hospital. Before that, she tried to purchase 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 say many people have lost Medicaid coverage due to paperwork glitches and other administrative mistakes.

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."