Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of a sprawling rollback of a pandemic-era policy that barred states from taking people out of the program.
Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients failed to return documentation to verify their eligibility or could not be located. The large number of terminations for procedural reasons suggests that many people may be losing their coverage even though they still qualify for it. Many of those who have fallen have been children.
From the start of the pandemic until this spring, states were prohibited from kicking people out of Medicaid under a provision in a coronavirus relief package passed by Congress in 2020. The guarantee of continued coverage prevented people from having checks regular eligibility during the public health crisis and caused Medicaid enrollment to rise to record levels.
But the policy expired at the end of March, setting off a huge bureaucratic task across the country to verify who is still eligible for coverage. In recent weeks, states have begun releasing data on who has lost coverage and why, offering a first glimpse of the punishing price the so-called relaxation is exacting on some of the poorest and most vulnerable Americans.
So far at least 19 states they have started to remove people from the lists. An exact total of how many people have lost coverage is not yet known.
In Arkansas, more than 1.1 million people, more than a third of the state’s residents, had Medicaid at the end of March. In April, the first month that states could start removing people from the program, about 73,000 people lost coverageincluding some 27,000 children under the age of 17.
Among those ruled out was Melissa Buford, a diabetic with high blood pressure who earns about $35,000 a year at a health clinic in eastern Arkansas that helps families find affordable health insurance. Her two adult children also lost coverage from her.
Like more than 5,000 people in the state, Ms. Buford, 51, was no longer eligible for Medicaid because her income had increased. A notice she received from her informing her that she didn’t qualify for her upset her so much that she threw it away.
But most of those who lost coverage in Arkansas were dropped for procedural reasons.
Daniel Tsai, a senior official at the Centers for Medicare and Medicaid Services who is helping to oversee the Biden administration’s rollback process, said more outreach was needed to help those who lost coverage that way. He said federal officials were in regular contact with state officials across the country to review early termination data and see if people who lost coverage had a fair chance to prove their eligibility.
Gov. Sarah Huckabee Sanders of Arkansas, a Republican, has framed the rollback as a necessary process that will save money and allow Medicaid to work within its intended scope.
“We are simply removing ineligible participants from the program to reserve resources for those who need them and to comply with the law,” Ms. Sanders wrote in a opinion essay in The Wall Street Journal this month. He added that “some Democrats and activist journalists oppose Arkansas’ actions because they want people to remain dependent on the government.”
Medicaid, which is funded jointly by the federal government and the states, has become an increasingly important component of America’s safety net. At the beginning of this year, 93 million people, more than one in four Americans, signed up for Medicaid or the Children’s Health Insurance Program, up from 71 million before the pandemic.
What has happened in Arkansas so far offers evidence of the widespread disruption the rollback process is likely to wreak on homes across the country in the coming months, forcing Americans to find new insurance or figure out how to get coverage back. of Medicaid that they lost. procedural reasons. federal government has projected that about 15 million people will lose coverageincluding nearly seven million people who are expected to be removed despite still being eligible.
Among the biggest questions ahead is how the process will affect children. In Florida, for example, a child in remission from leukemia who needs a biopsy you recently lost your coverage.
Researchers at the Center for Children and Families at Georgetown University estimated before the outcome that more than half of the children in the United States they were covered by Medicaid or CHIP. Many children who lose coverage will be dropped for procedural reasons, even though they are still eligible, said Joan Alker, the center’s executive director.
“Those kids have nowhere else to turn for coverage,” he said. “Medicaid is the largest single insurer for children. This is hugely important to them.”
In Arkansas, many of the children who lost Medicaid were “the poorest of the poor,” said Loretta Alexander, director of health policy for Arkansas Advocates for Children and Families. She added that losing coverage would be especially damaging for young children who need regular developmental checkups early in life.
Most states are taking about a year to complete the rollback, and each uses its own approach to get people off Medicaid. But in Arkansas, legislation passed in 2021 required state officials to complete the process in just six months. State officials verified the eligibility of children with Medicaid coverage early in the process because they make up a substantial portion of those enrolled, according to Gavin Lesnick, a spokesman for the state Department of Human Services.
In her opinion essay, Ms. Sanders noted the campaign the state has undertaken to alert residents to the decommissioning, called Renew Arkansas.
“We are hiring additional staff and recruiting volunteers to help,” he wrote. “We text, email and call tens of thousands of Arkansans who may not now be eligible for Medicaid, and we’ve made a special effort to reach out to people with disabilities, people who have moved, people living with diseases such as cancer, those receiving dialysis and women who are pregnant.
Local health workers like Ms. Buford are trying to help people regain coverage if they still qualify. She said she had worked with 50 to 75 Medicaid recipients who had lost coverage in April, helping them fill out forms or answering their questions about verifying their eligibility.
Other states have also removed large numbers of Medicaid recipients for procedural reasons. In Indiana, almost 90 percent of the approximately 53,000 people those who lost Medicaid in the first month of the state’s dismantling were expelled on those grounds. In Florida, where almost 250,000 people lost Medicaid coverage, procedural reasons were to blame for the vast majority.
In addition to taking different approaches to removing people from Medicaid, states are also publishing data on their progress in different ways, making it difficult to compare their strategies in the early stages of termination. “We are comparing apples to oranges to tangerines,” Ms Alker said.
Some people who lose Medicaid coverage are expected to get health insurance through their employer. Others are likely to turn to the Affordable Care Act marketplaces to sign up for private insurance, and many of them will be eligible for premium-free plans.
Debra Miller, 54, of Bullhead City, Ariz., lost Medicaid coverage in April after her roughly $25,000 annual salary as a Burger King cook left her ineligible. Ms. Miller, a single mother with diabetes and hypothyroidism, worked with an insurance counselor at North Country HealthCare, a network of federally funded health clinics, to enroll in a Marketplace plan with a monthly premium of approximately $70.
“It’s a fight because it’s a new bill that I haven’t had before,” he said. Her new plan, she added, doesn’t include vision insurance, leaving her worried about paying for the vision appointments she needs as a diabetic.
Ms. Buford said that for some people in Arkansas, Marketplace coverage would be too expensive.
“You have a car, a mortgage, children, food,” he said. “You really don’t have much left to pay that much for health insurance.”
Ms. Buford said her work helping others find health insurance in underserved areas was a calling inspired by watching her grandmother struggle to pay for her medications and rely on food pantries. Ms. Buford went to a community college near her hometown so she could care for her ailing father, who passed away at age 40. “I love my job because I get to help people,” she said.
Now that she has lost her Medicaid coverage, Ms. Buford said she hopes to find an affordable plan on the market in the near future. The family plan offered by the clinic where she works is too expensive, she said.
“I’m thankful for what I have because someone else doesn’t have what I have,” Ms. Buford said. “I wish I could have kept my Medicaid.”