Some Americans unaware their insurance is funded by Medicaid

Some Americans who rely on Medicaid to pay for their health care don't realize their insurance is funded by that very program, which congressional Republicans are looking to shrink.

One reason is that state programs aren't always called "Medicaid." Many states have rebranded their programs with consumer-friendly names such as SoonerCare in Oklahoma, Apple Health in Washington, Medi-Cal in California or TennCare in Tennessee.

And nearly all states now use private insurance companies such as UnitedHealth or Blue Cross Blue Shield to run their Medicaid programs. That means Medicaid enrollees may hold an insurance card and paperwork with the name of a commercial insurance company.

"We toss around terms like 'Medicaid,' but we see so many of our patients not having [insurance cards or] anything that describes or uses the word 'Medicaid,'" said Dr. Adam Brown, a Washington, D.C.-based emergency physician and founder of a health care strategy firm.

"People oftentimes do not realize either that they have it, or know the value of what it does."

Medicaid is the health insurance program for people with low incomes or certain disabilities. About 72 million people, or about a fifth of all the people living in the United States, are enrolled. It operates with state and federal funding, but every state has the freedom to choose how to run its program, within federal rules.

As a result, Medicaid is a sprawling patchwork of programs that can confuse lawmakers and even top health officials, not to mention the average beneficiary. Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, incorrectly described basic elements of Medicaid and seemed to confuse it with Medicare during his January confirmation hearing before Congress.

Republicans in Congress are considering proposals to slash hundreds of billions of dollars from federal Medicaid funding as they look to offset trillions in tax cuts proposed by President Donald Trump. The specifics of the Medicaid cuts are still being hammered out. But any reductions to federal Medicaid spending would shift those costs to states, which would likely be forced to end services or cut coverage for certain groups of people.

"Part of the problem is when we hear people talk on television or hear lawmakers talk, there are many people that don't make the connection that they themselves are on [Medicaid] or that their hospital is very much dependent upon the dollars that come from Medicaid," Brown said.

"Calling it one thing and branding it something very different, that makes it challenging for people to understand the connection or the value in the product that they actually have."

About 3 in 4 people who have Medicaid are enrolled in managed care organizations (MCOs), according to the latest national data. Most of these are private plans operated by companies such as UnitedHealth Group and Centene. But the branding from these companies can distance recipients from the fact that their care is paid for with public funds.

When Brown worked in emergency medicine, he had many patients who had insurance through Medicaid.

"There were times they would show me their card, and it would have commercial branding, like a Blue Cross Blue Shield," he said. But as they talked, "I noticed there was a lack of understanding that they were on a Medicaid-supported or state/federal-supported program."

Millions of people who are enrolled in Medicaid mistakenly believe they're uninsured, Dr. Ben Sommers, a Harvard health economist and physician, told Stateline.

"It is a longstanding issue that got worse during the pandemic," he said.

He and fellow researchers found that the gap between the number of people who have Medicaid and the number who think they have it jumped during the pandemic, to about 18.5 million people. This was due to a lack of public understanding about a COVID-era rule that granted continuous Medicaid coverage to people without requiring them to re-enroll, researchers found.

Sommers expects the gap will eventually return to pre-pandemic levels, or nearly 6 million people.