For three years during the COVID-19 pandemic, from March 2020 to March 2023, the Medicaid continuous enrollment provision halted Medicaid disenrollment.1 This meant that those already on Medicaid did not have to go through any kind of renewal process to stay on Medicaid. In fact, states were prohibited from kicking anyone off Medicaid unless the person dies, moves out of state, or request a disenrollment.
This prohibition resulted in more than 94 million people being enrolled in Medicaid/CHIP in March 2023, an increase of over 22 million from February 2020.1 That is about 1 in 4 people in the U.S. on Medicaid, which is a jointly funded (by states and the federal government) health program for those with low incomes and for some with disabilities.
However, along with the close of the public health emergency (PHE), the Medicaid continuous enrollment provision ended on March 31, 2023, starting the “unwinding” process where states redetermine eligibility for all Medicaid enrollees and disenroll those who are no longer eligible or who may remain eligible but are unable to complete the renewal process.
As a result, millions of people have already lost Medicaid, and millions more are expected to lose coverage by the end of the 14-month period given to states to complete the eligibility redeterminations.2 Currently, children account for over four in ten of Medicaid disenrollments.3
Of the more than 5.2 million that have lost Medicaid nationally so far, the Kaiser Family Foundation (KFF) reports that on average, 74% of people are losing coverage for procedural reasons and not because they actually no longer qualify for coverage.4 Procedural disenrollments occur from enrollees not having completed the renewal process for a variety of reasons including: states having outdated contact information and the enrollee not receiving the renewal notice in time as a result; the enrollee not understanding due to the language complexity and/or its meaning lost in translation; the enrollee failing to complete the renewal packets within a specific timeframe; and the state’s inability to process the submitted documents before one’s coverage is terminated.
For most people that lose coverage due to ineligibility, a different health insurance—from an employer or through Healthcare.gov—is available without having to wait for open enrollment. However, those who are wrongly cut off Medicaid can suffer significantly during their brief time without coverage, even if they are able to reenroll soon after.
Currently, the state of Florida is being sued for terminating Medicaid coverage without proper notice or the chance to contest the state agency’s decision. Per the Plaintiffs, their two-year old toddler with cystic fibrosis missed weeks of her prescription drugs, got sick, and accrued a $2,800 emergency room visit bill after the primary care doctor refused to see her without insurance.5 The Plaintiffs had contacted the state agency well before to ask for clarity after receiving the Medicaid notice but was reportedly met with hostility. The toddler’s Medicaid coverage ended on May 31, although she qualified under the “medically needy” category.
Attorneys for the plaintiffs believe this case to be the first lawsuit of its kind since the Medicaid “unwinding” began in April. This may be the first of many.
In any case, the important question for healthcare providers remains: How can providers advocate for patients during this “Great Unwinding” process? Ryan Crowley, the senior associate for health policy at the American College of Physicians, urges physicians to make patients aware of what is going on: “Raising awareness and compelling them to act is key.”6
Other professional organizations such as the American College of Emergency Physicians released a statement advising the frontline workers to “encourage patients with Medicaid to reach out to their Medicaid office to confirm their contact information is up to date and to ensure they will remain eligible.”7 That way, patients will receive notifications for potential disenrollment.
The American Academy of Family Physicians also released an article addressing this issue and encouraging the physicians to alert patients to check their mail for potential renewal notices and to complete and return any required paperwork.8 Patients may also benefit from handouts/posts informing them on how to get help with renewals or re-enrollment if patients have lost coverage or happen to lose coverage in the upcoming months.
After all, medical providers are patients’ greatest advocates and need to help ensure that they do not lose critical coverage during this time of transition.
Yuna Han is an avid writer, a budding physician, a fervent believer, and a happy wife. She is currently pursuing a combined MD and Masters degree in Religion and Society at Loma Linda University. Besides medicine and theology, Yuna is passionate about languages, traveling, dogs, and staying active.