Thousands of La. Medicaid enrollees may lose coverage pandemic protections end. Here's what you need to know

Louisiana officials are gearing up to verify that the state's two million residents enrolled in Medicaid are still qualified to receive benefits as pandemic protections expire. Experts fear the process, which begins in April, may disrupt health care access, resulting in delayed care and potentially tens of thousands of low-income residents joining the ranks of the uninsured.

To qualify for Medicaid, households cannot make more than 138% of the federal poverty level monthly. That's about $1,677 for one person or $3,450 per month for a family of four. During the pandemic, safeguards were put into place that kept states from dropping residents if they earned more than that as part of the public health emergency declaration.

Under those provisions, the federal government picked up more of the tab to cover Medicaid insurance, which is typically funded both by state and federal governments. In exchange for the extra cash, states agreed not to drop anyone from Medicaid during the pandemic.

Those protections keeping people insured will end on April 1. Called Medicaid "unwinding," the process will take place across the U.S., with states responsible for coming up with their own plans to inform residents of the expiring coverage and offer alternatives to help them maintain health insurance.

In Louisiana, Medicaid ballooned, adding nearly 442,000 enrollees over the course of the pandemic, an increase of about 28%. As of Jan. 2023, 2,032,783 were enrolled in Louisiana.

"That's over 40% of the state's population, and the end of the continuous coverage provision will be the biggest mass renewal process in our state's history," said Courtney Foster, a Medicaid policy advocate for Louisiana Budget Project, a private organization that analyzes fiscal issues and their impact on low- and moderate-income residents.

While states have always conducted regular checks for eligibility, that was on pause for several years, and now there will be a lot more people to check.

"This is a big undertaking, and it's mainly due to the fact that we have been under COVID public health emergency rules for three years," said Tara LeBlanc, Medicaid executive director.

LeBlanc did not say how many Louisiana residents might fall off of Medicaid or become uninsured as a result of the unwinding.

Some estimates suggest levels of Medicaid among non-elderly people would drop back to early 2020 levels by 2024, according to a report by the Robert Wood Johnson Foundation and the Urban Institute that was published in December. If that prediction holds, as many as 268,000 people in Louisiana under the age of 64 would lose Medicaid insurance. If overall Medicaid numbers fell to pre-2020 levels, over 400,000 who currently have Medicaid would lose it.

While some of those people will have coverage through their employment or the insurance marketplace, the report predicts about 65,000 more residents will become uninsured as a result.

LeBlanc said the ways the pandemic changed financial situations and job status made it hard to nail down how many people will be disenrolled.

"I think we can all agree that our life has changed from pre-COVID to post-COVID," said LeBlanc. "Until we really redetermine and look at everyone's situation and their circumstances, it's a guess of how many people would disenroll."

How it will work

Every person on Medicaid will be reviewed during a year-long process starting in April. The state expects about half of the two million enrolled will be automatically renewed using federal data to check income. Those people will receive letters stating their coverage is renewed for another year.

Those who need to prove they still qualify will receive a letter and renewal packet in the mail from Medicaid, but not everyone will receive a letter right away. The state has divided Medicaid members over the remaining months so they can handle the volume of people who will need help with verification. The first letters will go out in May, and enrollees will have until June to respond. If they do not prove eligibility, the first cohort will lose coverage by July 1.

If the state has a phone number associated with the enrollee's account, it will also send text reminders. LeBlanc said they'll be working with community groups and schools to raise awareness about verification and other ways to get insurance if residents no longer qualify. They'll also advertise using billboards.

A massive undertaking

Because the state will need to verify over 2 million enrollees, policy experts point out that the massive undertaking could result in people losing coverage for simple reasons. such as not updating their address over the last few years or missing a notification letter, said Foster.

"If we get this wrong, Louisiana families will lose health coverage for no good reason," said Foster. "We don't want anyone to be losing coverage over a piece of mail."

Typically, when eligible people lose coverage because of paperwork issues, they may delay care and stop regularly visiting their doctors, said Foster. That results in expensive treatments as health issues snowball.

"If someone has a scratchy throat, rather than being able to just go to the doctor, they may wait until that scratchy throat becomes a bigger infection," said Foster. "Next thing you know, they're really sick and then they go to the emergency room rather than getting it treated earlier."

When people lose health care coverage, the burden of disease goes up, said Mark Diana, a health policy expert at Tulane University. Hospitals also lose out on money for those patients, especially if they wait to get care until it's an emergency when the cost of care is high.

"We'll probably see a rise in things like uncompensated care costs in hospitals and higher ER visits," said Diana. "When you lose insurance, that's typically what people do."

Louisiana has also had a tumultuous three years that resulted in people moving around a lot, Foster pointed out.

"We've had a lot of natural disasters and folks getting evicted and needing to move for whatever reasons," said Foster.

The state will eventually reimplement automatic wage checks from Louisiana businesses to flag people the state targets for disenrollment because they have made too much money in a quarter. It's not decided when those will begin, said LeBlanc.

Historically, that has created a lot of people getting kicked off Medicaid only to requalify a few months later, said Diana, because Louisiana has many gig or seasonal workers. That process is costly for the state and disruptive for health care.

To prevent eligible people from losing coverage, the state has hired 50 call center agents and is encouraging people on Medicaid to update their contact information. They can do that by logging on to MyMedicaid.la.gov, emailing [email protected], calling their health plan on the number on their ID card or calling Medicaid's customer service hotline at 1-888-342-6207.