As a result of the pandemic rule, coverage for as many as 15,000,000 people could be lost.
Prior to the crisis, U.S. States regularly checked Medicaid recipients' eligibility to ensure they were still eligible for coverage. This was based on income and residency. This is usually 138% of the federal poverty level. The state-specific rates vary. To qualify, one California person cannot earn more than $17 609 per year.
However, during the pandemic, a provision of the Families First Coronavirus Response Act put a pause button on eligibility status checks. This ensured that recipients received continuous Medicaid coverage during the crisis. Many signed up for Medicaid coverage after losing their jobs, and often their insurance. This helped to increase the number of beneficiaries in the program to 76.7 million as of July 2021 (the latest data available). That's a 19% increase since 2019.
According to Matthew Buettgens (senior fellow at Urban Institute), the pause in the eligibility status check process will end in April. This could mean that as many as 15,000,000 people may be thrown off Medicaid. This is a complicated issue because low-income individuals may lose coverage by not providing income verification.
Buettgens stated that states are processing an unprecedented amount of participants in a very short timeframe. "There are concerns that this could lead more people to be unenrolled than they need, even though they may still be eligible."
Telephone wait time of two hours
Many health care advocates worry about how states will handle eligibility checks for record numbers of enrollees. This is despite the fact that agency staffing levels are low due to a national labor shortage or budget cuts. Texas, for example, added 1 million Medicaid beneficiaries during the pandemic. However, its Medicaid division has been reduced by the Houston Chronicle.
"We are concerned that a lot people don't know they must enroll. If they do, how quickly will the state process them? Jana Eubank is the executive director of Texas Association of Community Health Centers.
She also noted that updating one's eligibility requirements can take time for Medicaid recipients. Eubank said that enrollees who have not logged in to the online system to update their information might have forgotten their password. However, the Texas system does not allow for the recovery of forgotten passwords electronically.
"To reset your password, you must call 211. In some cases, we hear from patients that they have to wait up to two hours," she said, referring to the Texas social service hotline.
Prior to the pandemic, Medicaid enrollment had been falling. The Kaiser Family Foundation reported that the number of Medicaid enrollees fell by 3% between December 2017 and December 2019. The analysis revealed that this was partly due to the U.S.'s growing economy over the period.
However, this trend was reversed by the pandemic. The pandemic caused the economy to collapse and millions lost their jobs. In response, lawmakers added a provision in the Families First Coronavirus Response Act. This allowed states to receive more Medicaid funding.
Medicaid enrollment has been increasing for decades, despite the drop in enrollment prior to the pandemic. In 2000, 34.5 million people were enrolled. This is less than half the current enrollment , according to the Medicaid and CHIP Payment and Access Commission. The program's spending has increased, with its outlays increasing by more than three times from $206 billion in 2020 to $683 billion in 2020.
The Biden administration extended for a period of 90 days in January to reflect its conclusion that the U.S. is facing a public health emergency. Mid-April will see the end of sweeping Medicaid relief if there is no extension. This means that states will have to resume eligibility status checks despite the increase in recipients.
Buettgens stated that states "are going have to determine eligibility for an increased population than they've ever had" and could do so very quickly.
Another question is: What will happen to 15 million people who could lose coverage this year, if eligibility checks resume? Buettgens analysis showed that only about one third of those who are eligible for Affordable Care Act's subsidized private healthcare will be able to do so. Nearly all the rest will likely receive health care through their employers, given the improved labor market and increased benefits offered by employers to recruit workers.
The analysis showed that these families will have to pay higher premiums and more out-of-pocket expenses for their health insurance. Experts said that there are risks for these households to choose not to have health insurance coverage due to the higher costs or to fall through the cracks because they failed to check their eligibility status.
Buettgens stated that if people do not enroll in other forms of coverage, either because they aren't sure what they're eligible for, or because it is too expensive, this could result in an increase in the number of uninsured. It is an unprecedented situation, there is much uncertainty.