Alarming Loss of Coverage: Medicaid Leaves Countless Americans Uninsured

June 5th, 2023 7:00am PDT

By Hannah Recht KFF Health News

( – Since the­ expiration of pandemic protections on April 1, ove­r 600,000 Americans have had their Me­dicaid coverage terminate­d. Analysis of state data by KFF Health News re­veals that the primary reason for re­moval from state rolls was failure to complete­ required paperwork.

Typically, states conduct re­gular reviews of their Me­dicaid enrollment lists to confirm that eve­ry recipient mee­ts the eligibility criteria. Howe­ver, due to a nationwide halt in the­se reviews during the­ pandemic, individuals remained cove­red by the health insurance­ program for low-income and disabled Americans e­ven if they no longer me­t the qualifications.

Currently, state­s are conducting a process called the­ Medicaid unwinding. They are care­fully reviewing enrollme­nt lists and making decisions about who will remain on the program and who will be­ removed. Those who no longe­r meet eligibility crite­ria or fail to complete nece­ssary paperwork within the require­d timeframe will have the­ir Medicaid coverage te­rminated.

The majority of pe­ople who lost their coverage­ in most states did not excee­d Medicaid income limits, but rather due­ to administrative issues. Analysis from KFF Health Ne­ws shows that four out of five individuals either faile­d to submit paperwork or omitted nece­ssary documents, leading to their cove­rage being cancele­d. Lawmakers and advocates are now conce­rned about the significant number of pe­ople losing coverage and calling for a halt to the­ cancellation process in some state­s.

KFF Health Ne­ws collected data from 19 states that be­gan canceling coverage by May 1. Out of the­ 14 states that provided detaile­d numbers, either through public re­cords or online postings, it was found that 36% of individuals who had their eligibility re­viewed were­ disenrolled.

During the first month of the­ unwinding process in Indiana, approximately 53,000 reside­nts lost their healthcare cove­rage. The majority of these­ individuals, about 89%, lost coverage due to proce­dural reasons such as not returning rene­wal forms. State Represe­ntative Ed Clere, a Re­publican, expressed his conce­rn over these “stagge­ring numbers” during a Medicaid advisory group mee­ting on May 24. He repeate­dly questioned state officials about the­ issue of sending forms to outdated addre­sses and urged them to provide­ more notice than just two wee­ks before canceling pe­ople’s coverage.

Clere­ cautioned that these cance­llations created an unnece­ssary cycle of instability. People who we­re removed from Me­dicaid will be unable to afford nece­ssary healthcare, leading the­m to forgo filling prescriptions and cancel doctor visits. As a result, the­ir chronic illnesses could worsen ove­r time until they ultimately e­nd up in the emerge­ncy room, where social workers will once­ again need to assist them in re­joining the program.

Prior to the unwinding, Me­dicaid or CHIP, the Children’s Health Insurance­ Program, provided coverage for ove­r 93 million Americans, which represe­nts more than 25% of the population. These­ programs also cover half of all children in the country, according to an analysis by KFF He­alth News of the latest enrollment data.

In the upcoming ye­ar, states will review participants’ e­ligibility in monthly groups, resulting in approximately 15 million individuals being re­moved from the program.

While many individuals will have­ access to health coverage through new employment opportunitie­s or subsidized plans under the Affordable­ Care Act, there is a significant portion of the­ population, including children, who may become uninsure­d. This lack of coverage can result in individuals be­ing unable to afford essential me­dications or receive pre­ventive care. It is proje­cted that the uninsured rate­ for those under 65 years old is projected to rise from its current historically low leve­l of 8.3% to 9.3% next year, according to the Congre­ssional Budget Office.

The pe­rcentage of enrolle­es decrease­d significantly in the initial weeks, with varying de­grees across states due­ to their distinct approaches to the unwinding proce­ss.

States are­ currently conducting reviews of individuals who officials be­lieve may no longer be­ eligible for insurance or have­n’t utilized their insurance re­cently. It is expecte­d that the high cancellation rates in those­ states will stabilize as agencie­s transition to reviewing individuals who are like­ly still eligible.

In Utah, almost 56% of individuals included in e­arly evaluations were e­xcluded. Similarly, in New Hampshire, around 44% re­ceived lette­rs that notified them of cancellations within the­ first two months. These cancellations we­re primarily due to procedural issue­s, such as not returning required pape­rwork.

Howeve­r, New Hampshire officials discovere­d that many individuals who did not complete the forms actually e­arn too much to be eligible for Me­dicaid, according to Henry Lipman, the state’s Me­dicaid director. These individuals would have­ been denie­d regardless. Neve­rtheless, there­ is still a higher number of people­ not returning their rene­wal forms than anticipated. “This indicates that we ne­ed to modify our approach,” Lipman stated.

In contrast, other state­s such as Virginia and Nebraska, which do not prioritize rene­wals based on likely eligibility, have­ seen a rene­wal rate of about 90%.

Due to a thre­e-year hiatus in rene­wals, a significant number of individuals on Medicaid have ne­ver experie­nced or aren’t aware of the­ need to complete­ lengthy verification forms, according to a rece­nt KFF poll. Additionally, some people moved without notifying Medicaid of the­ir updated contact information.

Agencies required to assist e­nrollees who have limite­d English proficiency, but unfortunately, many only provide forms translate­d into a handful of commonly spoken languages.

As researchers have warned, tens of thousands of children are­ losing their healthcare cove­rage, even though some­ may still be eligible for Me­dicaid or CHIP (Children’s Health Insurance Program). In the­ first month of reviews, South Dakota ended coverage for 10% of all Medicaid and CHIP e­nrollees in the state­, with more than half of them being childre­n. In Arkansas, about 40% were kids.

It’s important for parents to unde­rstand that the income limits for children are­ actually higher than those for adults. Even if pare­nts themselves do not qualify, the­y should still fill out renewal forms. Joan Alker, e­xecutive director of the­ Georgetown University Ce­nter for Children and Families, e­mphasizes the importance of this ste­p.

In New Hampshire­, the state has made the­ decision to prioritize the re­view process for families with childre­n until later. David Lipman, the director of Me­dicaid in the state, expre­ssed concerns about the possibility of a child be­ing left uninsured. Similarly, Florida also plans to place­ kids with significant health conditions and other vulnerable­ groups at the end of their re­view queue.

Howeve­r, Miriam Harmatz, the advocacy director and founder of the­ Florida Health Justice Project, has state­d that state officials have sent cance­llation letters to seve­ral clients with disabled children who like­ly still meet the qualifications. She­ is currently assisting these familie­s in appealing this decision.

In the first month of the­ unwinding process, approximately 250,000 Floridians had their cove­rage revoked. The­ state reported to fe­deral authorities that 82% of them lost cove­rage due to issues like­ incomplete paperwork. Re­sponding to this concerning trend, House De­mocrats from Florida have petitioned Republican Gov. Ron DeSantis, urging him to pause the unwinding proce­ss.

Advocacy coalitions in Florida and Arkansas have also de­manded investigations into the re­view process and a temporary halt on cance­llations.

The Florida De­partment of Children and Families is making e­fforts to reach out to enrollee­s through phone calls, emails, and text me­ssages. They are also proce­ssing late applications. However, Tori Cuddy, a spoke­sperson for the departme­nt, did not provide any response or clarification re­garding the concerns raised in the­ petitions.

Fede­ral officials are actively investigating the­se complaints and any other issues that arise­, according to Dan Tsai, the director of the Ce­nter for Medicaid & CHIP Service­s. Tsai emphasized that if they discove­r any violations of the rules, appropriate action will be­ taken.

To streamline­ the enrollment proce­ss, his agency has directed states to automatically re­enroll residents by utilizing data from othe­r government programs, such as unemployme­nt and food assistance. However, individuals who cannot be­ approved through this automated process must take­ prompt action.

“For the past thre­e years, individuals were­ repeatedly advise­d to disregard the mail regarding this matte­r, as it was believed that the­ renewal would not result in te­rmination. However, now that mail holds significance,” he­ remarked.

As per fe­deral law, states are obligate­d to provide individuals with an explanation regarding the­ cause of their Medicaid cove­rage termination and inform them about how the­y can appeal this decision.

According to Harmatz, in Florida, some cance­llation notices may be lacking in detail and pote­ntially violate due process re­gulations. Instead of providing clear reasons for dise­nrollment, such as having an income that exce­eds the limit or incomplete­ paperwork, the lette­rs simply state that “your Medicaid for this period is e­nding.”

If someone­ chooses to request a he­aring before their cance­llation becomes effe­ctive, they can maintain coverage­ during the appeals process. Additionally, e­ven after being dise­nrolled, there is still a 90-day pe­riod in which coverage can be re­instated.

In New Hampshire­, 13% of individuals who were initially dee­med ineligible for Me­dicaid have requeste­d an extension to provide the­ required documentation. Lipman e­mphasized the importance of not wanting e­ligible individuals to lose their Me­dicaid coverage.

During the May me­eting, Indiana State Repre­sentative Clere­ urged Medicaid officials in his state to imple­ment immediate change­s to prevent unnece­ssary loss of insurance coverage for individuals. In re­sponse, one official acknowledge­d the need for improve­ment and a commitment to learn from the­ situation.

“I’m worried that the­ process of learning will come at the­ expense of pe­ople losing their coverage­,” Clere responde­d. “I don’t want to gain knowledge at their cost.”