Halfway to what will be the biggest purge of Medicaid recipients within a year, enrollment in the government-run health insurance program is on track to return to pre-pandemic levels.
Medical helpwhich covers low-income people and people with disabilities, as well as Children’s Health Insurance Programknown as CHIP, reached a record 94 million enrollees due to a rule that States are prohibited from terminating coverage during the COVID-19 national public health emergency.
But since April, states have removed more than 16 million people programs in a process known as “unwinding,” according to KFF estimates compiled from state-level data.
While many beneficiaries are no longer eligible because their income has increased, millions of people have been fallen from the rollers for procedural reasons such as failure to respond to notices or return documents. But at the same time, millions of people have re-registered or registered for the first time.
The bottom line: According to KFF, registrations are down by about 9.5 million people from April’s record. That puts Medicaid and CHIP enrollment on track to look, by the end of this year’s rollout, somewhat like what it was at the start of the pandemic: about 71 million people.
“What we’re seeing is no different than what we saw before the pandemic: it’s just happening on a larger scale and faster,” said Larry Levittexecutive vice president of health policy at KFF.
Disenrollment rates have long been a hallmark of Medicaid. Before the pandemic, about 1 million to 1.5 million people nationwide fell out of the Medicaid program each month, including many people who qualified but failed to renew their coverage, Levitt said.
During the process, many people were unsubscribe within a shorter period. In some ways – and in some states – the situation has been worse than expected.
The Biden administration predicted that about 15 million people would lose their Medicaid or CHIP coverage during the unwinding period, nearly half of them due to procedural problems. Both predictions turned out to be weak. Based on the data reported so far, unsubscribes are likely to exceed 17 millionaccording to KFF — 70% for procedural reasons.
But about two-thirds of the 48 million beneficiaries whose eligibility has been reviewed so far have had their coverage renewed. About a third lost it.
The federal government has given most states 12 months to complete their deregistrations, starting with the first deregistrations last year between April and October.
Timothy McBridehealth economist at Washington University in St. Louis, said the historically low unemployment rate That means people who lose Medicaid coverage are more likely to find job-based coverage or be better able to afford plans on the Obamacare marketplaces. “That’s one of the reasons the Medicaid decline isn’t much worse,” he said.
There are big differences between states. Oregon, for example, disenrolled only 12% of its beneficiaries. Seventy-five percent were renewed, according to KFF. The rest is pending.
On the other end of the spectrum, Oklahoma dropped 43% of its beneficiaries upon unwinding, renewing coverage for only 34%. About 24% are waiting.
States have varying eligibility rules, and some make it easier to maintain registration. For example, Oregon allows children to continue on Medicaid until age 6 without having to reapply. All other enrollees receive up to two years of coverage, regardless of income changes.
Jennifer Harris, leading health policy advocate for Alabama rises, an advocacy group, said its state’s Medicaid agency and other nonprofits have communicated well to enrollees about the need to reapply for coverage and the state has hired more people to manage the increase. About 29% of beneficiaries in Alabama who were reviewed for eligibility were disenrolled for procedural reasons, KFF found. “Things are balanced in Alabama,” she said, noting that about 66 percent of registrations have been renewed.
State officials told the Legislature that about a quarter of people disenrolled during the disenrollment period were re-enrolled within 90 days, she said.
Alabama, one of the few states that declined to expand Medicaid under the Affordable Care Act, had about 920,000 Medicaid and CHIP enrollees as of January 2020. That number has grown to about 1.2 million in April 2023.
More than halfway through the unwinding process, the state is on track for enrollment to return to pre-pandemic levels, Harris said.
Joan Alker, executive director of the Georgetown University Center for Children and Families, said she remains concerned that the drop in Medicaid enrollment among children is steeper than usual. This is particularly troublesome because children generally qualify for Medicaid at higher family income levels than their parents or other adults.
During the unwinding, 3.8 million children lost Medicaid coverage, according to the center’s latest data. “Many more children are falling today than before the pandemic,” Alker said.
And when they are abandoned, many families struggle to put them back, she said. “The whole system is behind schedule and people’s ability to come back in a timely manner is more limited,” she said.
The big question, Levitt said, is how many of the millions left out of Medicaid are now uninsured.
The only state that surveyed disenrollees — Utah — found that about 30 percent were uninsured. Most others found health coverage through their employer or signed up for subsidized coverage through the Affordable Care Act marketplace.
What happened nationally remains unclear.
KFF Health Newsformerly known as Kaiser Health News, is a national newsroom that produces in-depth journalism on health issues.
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