States across the nation are rapidly removing residents from Medicaid, leaving a significant number of eligible individuals without access to essential healthcare.
Despite the Biden administration’s efforts, the jointly run federal and state program’s unique structure severely limits their ability to prevent these painful coverage losses. Shrouded in alarming statistics, data from KFF (formerly the Kaiser Family Foundation) reveals that more than 1.5 million people in 25 states and the District of Columbia have already been disenrolled from Medicaid due to the unwinding of the pandemic continuous coverage provision.
Notably, 73 percent of these disenrollments are classified as procedural terminations. This means that those affected still meet the eligibility criteria based on income or disability status but have encountered administrative struggles that prevented them from reenrolling. Missed phone calls from state health officials or other procedural missteps have led to countless eligible individuals losing their coverage. These disenrollments are the continuous coverage requirement implemented during the COVID-19 public health emergency.
SmartNews mentioned that the expiration of this requirement in March removed the safeguard that prevented states from removing individuals from Medicaid rosters during the emergency. As a result, Medicaid recipients must now prove their eligibility, leaving many vulnerable individuals at risk of losing their coverage. Some states, particularly those with a Republican majority, view this as an opportunity to cut costs and reduce their Medicaid rolls quickly. The Biden administration and lawmakers on Capitol Hill are grappling with finding practical solutions to address this urgent issue. To stem the tide of disenrollments, the Department of Health and Human Services (HHS) recently provided states with additional flexibilities.
These measures include allowing managed care firms to complete Medicaid renewal forms on behalf of enrollees and enabling pharmacies and community-based organizations to assist with reinstating coverage for those who were wrongly disenrolled. However, these efforts fall short of utilizing the full extent of the HHS’s authority: cutting off funding to individual state Medicaid programs. While CMS (Centers for Medicare & Medicaid Services) can influence state programs by controlling the purse strings, exercising this authority is uncommon, according to SmartNews.
Corrective action plans and withholding of federal funds are rarely implemented, and such actions can be protracted processes. The situation’s urgency has prompted prominent Democrats on Capitol Hill, including Senate Finance Chair Ron Wyden and House Energy and Commerce ranking member Frank Pallone Jr., to urge the Biden administration to assume a more active role in overseeing state reassessments of Medicaid beneficiary eligibility. They have called on CMS to consider defunding state Medicaid programs if genuine efforts to prevent procedural terminations are not undertaken.
While federal oversight may have limitations, community involvement can play a pivotal role in ensuring that eligible individuals are aware of their options and rights, empowering them to seek the reinstatement of their coverage without unnecessary gaps.