Unwinding or Unraveling? Keeping the Fabric of Medicaid Intact

The COVID-19 pandemic showed that individual health and public health are inseparable. During this crisis, Medicaid played an important role as an essential source of health insurance for millions. But now, a COVID-era provision that kept people enrolled in Medicaid is expiring, and up to 15 million people are expected to lose these vital benefits over the next year.

To ensure that as many Americans as possible had health coverage during the height of the pandemic, the federal government required states to keep people continuously enrolled in Medicaid, in exchange for more federal funding. Medicaid is a public insurance program that provides health coverage to families and children with low income, including many with complex and costly health needs. Over 85 million people — or 1 in 5 Americans — receive health coverage through Medicaid.

Everyone has a right to affordable health care, no matter their income, race, gender, or where they are from.

But now that the public health emergency is ending, the continuous eligibility provision is being phased out. Over the next 12 months, all Medicaid enrollees will be required to go through a “redetermination” process to prove their ongoing eligibility for benefits.

As with many programs for people with low income, Medicaid requires enrollees to provide periodic and often burdensome proof of eligibility. With “redeterminations” suspended during COVID, the number of Medicaid beneficiaries rose to 92.3 million, a 29.8% increase from 2019. A 2019 report from the National Bureau of Economic Research found that expanding Medicaid saved over 19,000 lives over just a three-year period.

Medicaid is jointly funded by the states and the federal government. Although federal law sets broad requirements for program participation, individual states have great flexibility in how they design and administer the programs.

The government expects many current recipients to no longer qualify for Medicaid or to not re-apply. States have until the end of the year to determine eligibility but have broad discretion in how to handle “unwinding” pandemic rules.

Health justice is a racial justice issue: Half of the 15 million losing coverage are expected to be Black or Latino/a/x. Reasons why vary. Some make too much money to qualify. Others will not know they need to re-apply, while immigrants face unique hurdles in the re-application process because of their legal status.

States are responding in a variety of ways:

• Last month, North Carolina became the 40th state to accept federal funds to expand its Medicaid program.

• Seven other red states recently won Medicaid expansion by putting the issue on the ballot.

• 43 states plan to take up until December’s federally imposed deadline to determine eligibility, according to the Kaiser Health Foundation. This will help keep as many people enrolled as possible.

• Mississippi is one of just 10 states that continues to refuse additional federal funding, available since 2014. Residents in the country’s poorest state are paying the price, with Mississippi hospitals being under-staffed and over-burdened.

States can take action to ensure eligible people are not disenrolled. First, states should opt to give people as long as possible to complete the “redetermination” process. In Illinois, the Shriver Center on Poverty Law urged the Department of Healthcare and Family Services (DHFS) to conduct redeterminations over the next year. States can also determine ongoing eligibility for Medicaid by using data from other assistance programs. With our coalition partners, the Shriver Center successfully urged DHFS to determine eligibility by using data from the federal food assistance program, the Supplemental Nutrition Assistance Program.

Public education is crucial. The Shriver Center holds regular community-facing webinars in English and Spanish. We also provide Medicaid enrollment information on GetCareIllinois.org, a website that offers health coverage information in five languages.

Residents of Illinois — where Medicaid beneficiaries surged by 1 million during the pandemic — can expect to receive letters in the mail to re-enroll starting in May. To help legal aid groups with the coming transition, we have worked with Illinois’s Medicaid agency to create question-and-answer materials for direct providers.

Unwinding the public health emergency does not have to “unravel” Medicaid coverage for millions. Help yourself and others stay insured — tell your partners, communities, friends, and families to update their addresses and look for renewal notices in the mail and on their online benefits accounts. Remember, if you’re no longer eligible, you can find coverage through healthcare.gov.