Following the end of the pandemic emergency, states are disenrolling people from Medicaid.

ONE OF THE MAJOR IMPACTS Of the pandemic on health care was to increase the number of people covered by health insurance, particularly Medicaid.

To deal with the pandemic, Congress passed the Families First Coronavirus Response Act which, among other things, greatly increased funding for the expansion of Medicaid.

Under the Act, Medicaid and the related Children’s Health Insurance Program (CHIP) increased enrollment by 23.3 million people from February 2020 to March 2023, bringing the total of covered people to between 93 and 95 million.

Under the Act, states were not allowed to drop people from Medicaid or CHIP during that three-year period, even if the enrolled no longer met normal eligibility requirements. That part of the program was referred to as “continuous enrollment.” In exchange for not dropping people from Medicaid, states received a 6.2% increase in Medicaid funding (about $117 billion).

Eligibility requirements

Medicaid is a program funded by federal and state governments to provide health insurance to low-income individuals and families. In 2021, the cost of the Medicaid program was $734 billion, with 70% funded by the federal government and 30% funded by the states.

In most states, the eligibility threshold is set at 138% of the federal poverty level. In 2023, in the 48 contiguous states, the federal poverty level for an individual is $14,580 and $30,000 for a family of four.

Some states have more restrictive requirements; other states have more generous limits. For example, eligibility in Alabama is set at an income that is at or below 18% of the federal poverty level; for Florida, 28%. On the other end of the spectrum, the District of Columbia provides coverage up to 221% of the poverty level, and Connecticut provides coverage up to 160% of the poverty level.

Disenrollment begins

Continuous enrollment under Medicaid ended March 31, 2023. Since then, the federal government has directed states to disenroll people who are no longer eligible, and states have been given approximately year one to accomplish that.

The precise number of people who will be dropped is not known. The Kaiser Family Foundation, a leading healthcare research organization, estimates the number will be between 5.3 and 17 million. The federal government estimates 15 million.

The disenrollment will bring hardship to patients who lose coverage and to providers who will have difficulty obtaining reimbursement for the care they provide to patients who have been covered by Medicaid.

People most likely to be disenrolled

Those at the highest risk of being dropped from Medicaid coverage are those who are less able to advocate for themselves. Additionally, if people who had been covered have changed addresses, they might not receive notice of their lost coverage and might not be aware they need to reapply.

Those who are reapplying will need to meet current eligibility requirements, including income levels. Several million who reapply are expected to still be eligible.

Ways to help with reenrollment

To reduce the number of people who will lose health insurance, government agencies and providers can be proactive. In some cases, the government might reenroll people automatically if the government already has the information it needs, such as through unemployment records and records pertaining to people with disabilities.

Some managed care organizations have staff assigned to assist patients in obtaining coverage. Medical offices and pharmacies also can inquire about patients’ insurance status and make referrals as necessary.

Expansion of health insurance coverage during the pandemic through the Medicaid program and subsidies for private insurance reduced the number of uninsured in the United States to an all-time low of approximately 8%. Now that Medicaid’s continuous enrollment program has ended, the number of people without insurance will rise again. •