Medicaid enrollment set to plummet – what beneficiaries need to know

Millions of Americans will soon lose Medicaid coverage, as some pandemic-era provisions that kept people continuously enrolled in the program expire.

But those who find themselves newly ineligible for Medicaid have plenty of other options for affordable coverage. Licensed, professional agents and brokers can ensure they secure health plans that meet their needs and budget.

The looming exodus from Medicaid is a product of the Families First Coronavirus Response Act, which Congress passed in March 2020. It offered additional federal funding for Medicaid as long as states did not disenroll anyone from the program for the duration of the public health emergency.

This continuous coverage provision, and the enhanced federal funding, swelled Medicaid's rolls. Total enrollment in December 2022 was 85 million – up from approximately 64 million in February 2020.

This past December, Congress gave states the green light to review the eligibility status of people enrolled in their Medicaid programs beginning in April. States have 12 months to return to "normal," pre-pandemic eligibility and enrollment rules.

The federal government will gradually scale back the extra Medicaid dollars it has been sending to the states – until that enhanced match disappears entirely at the end of this year.

As a result, millions of people may have to find new health plans. The Department of Health and Human Services estimates that up to 15 million people may lose Medicaid and CHIP coverage.

About 45 percent of this group – 6.8 million people – will likely remain eligible for Medicaid. They'll just need to reconfirm their eligibility for the program with their state Medicaid agency.

Many beneficiaries are unaware of this requirement. They may ignore phone calls or letters from the state seeking to verify their eligibility. Or they may have moved and neglected to update their address with the state. In the end, they can be purged from Medicaid without knowing.

About 8.2 million Medicaid enrollees will need to find replacement coverage. Many will be able to do so through work. HHS projects that about 5 million will migrate from Medicaid to employer-sponsored insurance.

Another 2.7 million will likely be able to get subsidized coverage through the Affordable Care Act's exchanges. More than 60 percent of that group, HHS estimates, could qualify for zero-premium plans.

Of course, it can be difficult to wade through all the insurance options on the exchanges – or to figure out how to confirm eligibility for Medicaid.

Licensed, professional agents and brokers can help these millions of folks weigh their health insurance options. They have the knowledge and expertise to assist people with re-enrolling in Medicaid, if eligible – or to claim all the subsidies to which they may be entitled through the exchanges. Better yet, their services are generally free for consumers.

According to the most recent data from the Centers for Medicare and Medicaid Services, agents and brokers account for 71 percent of exchange enrollees. Consumers find their advice extremely valuable. A study from the Urban Institute found that 80 percent of adults who received external information about the exchanges said insurance agents and brokers were more helpful than other resources.

As states begin to cull their Medicaid rolls, it's critical that those who have relied on the program over the last few years understand all the affordable health insurance options that remain available to them. Agents and brokers can ensure that they do.

Janet Trautwein is CEO of the National Association of Benefits and Insurance Professionals (nabip.org). This piece originally ran in the South Florida Sun Sentinel.