Beginning on Saturday, states across the U.S. will start the process of stripping Medicaid coverage from millions of people as pandemic-related protections lapse, part of a broader unraveling of the safety net that was built to help families withstand the public health crisis and resulting economic turmoil.
Medicaid's continuous coverage requirements were enacted early in the Covid-19 pandemic to help vulnerable people maintain insurance amid the health emergency, resulting in record-high Medicaid enrollment.
But at the end of last year, congressional negotiators agreed on a bipartisan basis to set April 1 as the beginning of the "unwinding" process for the continuous coverage mandates, which prevented states from conducting regular eligibility screenings for Medicaid recipients.
The bipartisan deal gave states 12 months to determine who is still eligible for Medicaid, but some states—including Arkansas and South Dakota—are jumping at the opportunity to quickly remove people from the program. (State timelines for kicking off the unwinding process can be seen here.)
"Tonight at midnight some people in AZ, AR, ID, NH, and SD will lose their Medicaid coverage," Joan Alker, executive director of the Georgetown Center for Children and Families, tweeted Friday. "South Dakota is especially vexing as expansion kicks in July 1st. The state could structure their renewals to ensure that parents move seamlessly into expansion. But they are erroneously claiming federal rules mean they can't. Not true."
Residents of the 10 states that have refused lifesaving Medicaid expansion under the Affordable Care Act (ACA) are likely to be hit hardest by the end of continuous coverage requirements, which the Biden administration estimates could result in 15 million people losing health insurance nationwide—including millions of children.
"Because those states tend to make only the extremely poor eligible for Medicaid, they will have many people who make too much to qualify for the government health insurance but not enough to reach the income needed to get federal subsidies to afford health plans sold on ACA marketplaces—the coverage the administration is counting on as the main fallback," The Washington Post's Amy Goldstein reported earlier this week.
"The toll will be large, too, in 13 states that have not chosen to extend Medicaid benefits to women for a full year after they give birth," Goldstein added. "Texas falls on both lists."
Because of the administrative barriers associated with income verification and other eligibility tests, many people are likely to lose Medicaid coverage even though they're still eligible for the program.
The Health and Human Services (HHS) Department has estimated that nearly 7 million people could be removed from Medicaid despite still being eligible due to "administrative churning."
The consequences of what one commentator has dubbed "The Great Medicaid Purge" could be disastrous, given the health impacts associated with insurance loss.
As HHS summarized in a recent report:
People who experience churning or coverage disruptions are more likely to delay care, receive less preventive care, refill prescriptions less often, and have more emergency department visits. One study found that unstable Medicaid coverage increased emergency department use, office visits, and hospitalizations between 10% and 36% and decreased use of prescription medications by 19%, compared to individuals with consistent Medicaid coverage. Children with interruptions in coverage also are more likely to have delayed care, unmet medical needs, and unfilled prescriptions.
"I feel sick," said Adam Gaffney, an ICU doctor at the Cambridge Health Alliance. "Some 15 million people will be purged from Medicaid, including 7 million who actually remain eligible for the program but fail to jump through the bureaucratic hoops! Medicaid is not enough: we need seamless, lifelong universal care now."
The Medicaid continuous coverage requirements are the latest pandemic-era protections to fall in recent months.
Starting on March 1, enhanced Supplemental Nutrition Assistance Program (SNAP) benefits were cut off in dozens of states, slashing food aid for tens of millions.
Additionally, the boosted Child Tax Credit (CTC) expired in late 2021 due to opposition from Sen. Joe Manchin (D-W.Va.) and congressional Republicans, resulting in a rapid surge in child poverty. Shortly before the expanded CTC lapsed, boosted unemployment benefits that helped millions weather economic chaos ended.
As the pandemic-era safety net crumbles, congressional Republicans are looking to roll back Medicaid, SNAP, and other key programs even further with spending cuts and punitive work requirements.
"Republican calls to cut government funding put everything from child care to opioid treatment and mental health services to nutrition assistance at risk for millions," Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, warned earlier this week.