Medicaid: 3M could lose health insurance

States are preparing to remove millions of people from Medicaid as protections put in place early in the COVID-19 pandemic expire.

The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health coverage, threatening their access to care and potentially exposing them to large medical bills.

In California, where about 15.2 million people are enrolled in its Medicaid program, known as Medi-Cal, up to 3 million could lose coverage because they no longer qualify or fail to reenroll, state officials forecast.

This month, the state is launching a massive media campaign via radio, social media and billboards to alert Medi-Cal members that they must apply to renew their coverage this year.

In coming months, the state will enlist federally funded navigators and other community health workers to help people update their contact information and ease the re-enrollment process — or to shepherd them into new coverage, if their income exceeds Medicaid’s eligibility limits.

The outreach campaign is backed by $25 million in state funds, with material provided in 19 languages.

Still, state health officials worry that people may get left behind and that the state’s all-time low 7% uninsured rate could spike.

“We acknowledge that this is going to be a bumpy road,” California Health and Human Services Secretary Mark Ghaly said.

Federal health insurance subsidies will help prevent people from falling through the cracks, he said.

Almost three years ago, as COVID-19 sent the national economy into free fall, the federal government agreed to send billions of dollars in extra Medicaid funding to states on the condition that they stop dropping people from their rolls.

But legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.

Now, states face steep challenges: making sure they don’t inadvertently disenroll people who are still entitled to Medicaid and connecting those who no longer qualify to other sources of coverage, such as subsidized health plans on the Affordable Care Act marketplaces.

Even before the pandemic, states struggled to stay in contact with Medicaid recipients, who in some cases lack a stable address or internet service, do not speak English, or don’t prioritize health insurance over more pressing needs.

Ordinarily, people move in and out of Medicaid all the time. States, which have significant flexibility in how they run their Medicaid programs, typically experience significant “churn” as people’s incomes change and they gain or lose eligibility.

The so-called unwinding will play out over more than a year.

The Biden administration has predicted that 15 million people — 17% of enrollees — will lose coverage through Medicaid or CHIP, the closely related Children’s Health Insurance Program, as the programs return to normal operations.

While many of the 15 million will fall off because they no longer qualify, nearly half will be dropped for procedural reasons, such as failing to respond to requests for updated personal information, according to federal estimates.

Millions of people losing Medicaid coverage will be eligible for free or low-cost coverage through the ACA marketplaces, but choosing a plan is complicated.

Unlike Medicaid, so-called Obamacare plans often include deductibles and copayments — though some people, depending on income, can get financial help to lower those expenses.

California will move some people who lose Medicaid eligibility to a subsidized private plan on the state’s marketplace, Covered California.

Enrollees will have to agree and pay a premium if they don’t qualify for a free plan.

But for those who don’t qualify for a zero-premium private plan, the premium could be as low as $10 a month, said Jessica Altman, executive director of Covered California.