- Through the Families First Coronavirus Response Act, millions were allowed to maintain Medicaid coverage through the end of the pandemic in the United States.
- The nation’s pandemic emergency status ends on May 11, leaving many questioning what their health coverage will look like.
- Experts recommend households proactively communicate with their state’s Medicaid office to properly explore all of their options.
As many as 14 million people are estimated to be close to losing Medicaid coverage, as pandemic protections lift and states begin reassessing availability.
Since January 2020, more than 20 million people have enrolled in Medicaid. Many of them may have otherwise been ineligible for the program but were allowed to maintain coverage as a result of the Families First Coronavirus Response Act. That provision required states to allow those previously enrolled in the program to stay on their Medicaid plans through the end of the nation’s official public health emergency.
Now, with that emergency status lifting on May 11, the nationally mandated continuous Medicaid enrollment provision also ends, with states starting to reassess who is eligible for Medicaid coverage. Past Kaiser Family Foundation (KFF) estimates reveal 5.3 million to 14.2 million enrollees will lose their Medicaid coverage as states begin to unwind these COVID-era enrollment policies.
Gabriella Aboulafia, a researcher at the Harvard T.H. Chan School of Public Health, told Health this can be a fraught time for those who relied on Medicaid throughout the health crisis.
“While the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, and other groups, like safety-net providers and marketplace navigator organizations, have invested significant resources into mitigating potential coverage loss,” she explained. “People will still be at risk of falling through the cracks.”
The Realities of Losing Medicaid Coverage
This news is a pressing concern for millions nationwide. Some states will start the process of removing now-ineligible people from their Medicaid programs in April.
Recently, the KFF released new estimates that show enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) will have grown to a total of nearly 95 million people by the end of March 2023.
Robin Rudowitz, vice president at KFF and director of the Program on Medicaid and the Uninsured, put into context that pandemic-era policies provided states with enhanced federal matching funds. In exchange for that, they were prohibited from removing people from Medicaid enrollments.
“This provision has provided stable coverage for millions during the pandemic and has been a major factor in increased enrollment and reductions in the uninsured,” Rudowitz told Health. “States will need to conduct redeterminations for all Medicaid enrollees and many could be disenrolled over the next 12 to 14 months after the three-year pause in disenrollments.”
She explained that, for some, the process of reassessing Medicaid eligibility will be easy if they are in states that “verify ongoing eligibility through available data sources.” This could be from state wage databases, for instance.
“However, many enrollees are likely to need to take some action to ensure that coverage is continued so enrollees can maintain access to services and prescriptions they may need,” Rudowitz clarified.
Aboulafia referred to related statistics from a nonprofit research organization, Urban Institute, that estimate the number of those who will lose insurance will be even higher than we think—18 million people.
She also noted that federal estimates suggest about 45% of those projected to lose Medicaid will still be eligible. "People may experience inappropriate terminations—that is, having their benefits terminated despite remaining eligible—because of application complexity, paperwork hassles, and other difficulties navigating the renewal process,” she explained.
The fear of losing your health insurance is very real, and Rudowitz pointed to the negative trickle-down effect removing this many people from Medicaid might have—especially as the nation is just now coming out of the pandemic and facing an uncertain economic climate.
“KFF analysis shows that when people are disenrolled from Medicaid, 65% experience a period of being uninsured over the next year, Rudowitz said. “Those who are uninsured typically have worse access to health care services and go without needed care.”
Checking on Your Medicaid Coverage
When asked what tools will be put in place for people to check their Medicaid eligibility during this period a Centers for Medicare & Medicaid Services (CMS) spokesperson said in an email to Health that those now enrolled in Medicaid “should expect that states will restart the usual renewal process required annually” during its regular period. That means the process began as early as February 1. for some states.
To clarify when this process begins for specific states, the CMS spokesperson referred to official federal Medicaid resources that list the contact information of all state Medicaid agencies at the “Medicaid or CHIP State Map.”
Rudowitz added that current enrollees can also create an online account with their specific state Medicaid program to check their status and receive updates on their coverage.
“Enrollees should be aware that redetermination will be on-going and they should look for communication from Medicaid to know if they need to take any action to maintain coverage,” she said.
Aboulafia explained how one’s Medicaid eligibility is based on household income. In the states that have not expanded their Medicaid programs, you might have to meet other eligibility requirements like “pregnant women,” “children,” “adults in families with dependent children,” “older adults,” or "those with a disability.”
If your Medicaid program requests you to update any of this information and you fail to respond in a timely manner, Aboulafia noted there is a risk that you could lose your coverage. Staying proactive in your communication is crucial.
If I Lose Medicaid Coverage, What Happens to My Kids' Coverage?
In most states, eligibility levels for children are higher than they are for adults, Rudowitz explained.
"So, even if an adult is no longer eligible for Medicaid, children may still be eligible,” she continued. “Adults who are no longer eligible for Medicaid may be eligible for subsidized coverage on the Marketplace, often with zero premiums.”
Aboulafia added that “children are a group that states are very concerned about as they begin the redetermination process.”
She explained that a significant part of the growth seen in Medicaid and CHIP enrollment during the pandemic—especially in non-expansion states—has been driven by children.
“States are likely to redetermine households as a unit, so if an adult loses their Medicaid coverage, the child may, too. However, even if a parent loses coverage, their child may still be eligible for Medicaid or CHIP due to higher income thresholds for eligibility for children,” Aboulafia said.
She encouraged parents to, “still complete a Medicaid/CHIP application for their child, even if they themselves are no longer eligible for Medicaid.”
Remaining on Medicaid While Seeking Other Coverage
Aboulafia emphasized the importance of responding to your state’s Medicaid office with the requested information as soon as possible. States can start terminating coverage as early as April 1.
She said that people who lost coverage due to the end of the pandemic-era continuous Medicaid coverage requirements will be eligible for “the unwinding special enrollment period” and can sign up for marketplace coverage as soon as they lose Medicaid.
This is a special circumstance, Rudowitz added. “Generally, there would not be an option to prolong coverage for those who no longer meet eligibility criteria. Once a renewal process starts, individuals generally have 30 days to complete the process."
Looking for Other Options
When asked what resources are out there for those who will lose Medicaid coverage in the coming months, the CMS spokesperson answered that the federal government is "collaborating closely with state agencies, other federal agencies, and stakeholders to plan and prepare for the end of the continuous enrollment condition through regular workgroups, all-state calls, and individualized technical assistance.”
To that end, CMS has provided “extensive guidance” and resources to help states “transition back to normal operations.” They noted these resources are available publicly online. Beyond help to the states, the CMS “is preparing resources to help support individuals’ transition to other sources of coverage.”
Concerning alternative forms of health coverage, Aboulafia explained that generally depends on where a person lives. In most states, those who lose Medicaid can purchase alternate coverage from the state marketplace.
“Most people are eligible for some type of subsidy, which can help them afford the cost of their premiums. Subsidies are even more generous than they used to be before the pandemic started,” she said.
Rudowitz echoed those sentiments, saying that many who lose Medicaid eligibility and lack an affordable option for employer coverage could be eligible for Marketplace coverage “often with zero premium.”
She cautioned this isn’t an option for everyone nationwide.
“However, there are 11 states that have not adopted the Medicaid expansion established under the Affordable Care Act and those adults may fall into a coverage gap where their income is too high for Medicaid,” Rudowitz said. “But [they may be] below poverty so they are not eligible for subsidies in the Marketplace.”
Kaiser Family Foundation. Fiscal and enrollment implications of Medicaid continuous coverage requirement during and after the PHE ends.
Georgetown University Health Policy Institute. The Families First Coronavirus Response Act: Medicaid and CHIP provisions explained.
Kaiser Family Foundation. Medicaid enrollment growth: estimates by state and eligibility group show who may be at risk as continuous enrollment ends.
Urban Institute. The impact of the COVID-19 public health emergency expiration on all types of health coverage.
Department of Health and Human Services: Assistant Secretary for Planning and Evaluation. Unwinding the Medicaid continuous enrollment provision: projected enrollment effects and policy approaches.
Kaiser Family Foundation. What happens after people lose Medicaid coverage?.
Centers for Medicare & Medicaid Services. Renew your Medicaid or CHIP coverage.
Kaiser Family Foundation. Medicaid and CHIP eligibility and enrollment policies as of January 2022: findings from a 50-state survey - report.
Georgetown University Health Policy Institute. Child uninsured rate could rise sharply if states don’t proceed with caution.