Up to 15 million Medicaid beneficiaries could lose coverage as pandemic subsidies dry up by the end of the year. State officials say that eligible recipients should contact their state Medicaid office to ensure their coverage isn’t interrupted.
“There are substantial protections in place,” said Brian Blase, founder and president of the Paragon Health Institute (PHI), a nonprofit, nonpartisan research institute that evaluates government programs and develops policies.
PHI sponsored a June 27 webinar titled “Medicaid Redeterminations: Setting the Record Straight.” The webinar featured Kelly Garcia, director of the Iowa Department of Health and Human Services, and Janet Mann, deputy secretary of health and state Medicaid director for Arkansas. They discussed their states’ plans for reducing the Medicaid rolls.
Both said that their states have campaigns to reach out to people who may lose their coverage. An essential first step in protecting that coverage is to read the mail, they said.
Mann said that some enrollees have heard that President Joe Biden declared the public health emergency that authorized the extra funding is over. They expect the Medicaid rolls to be thinned and fear losing coverage even though they still qualify, so they ignore the notices that they receive in the mail.
Others know that they’re no longer eligible because they have employer coverage or make too much money. They see the mail from the state and toss it out.
Contacting the Community
Both officials said that the states aren’t just depending on the U.S. Postal Service to get the message out.The Arkansas Department of Human Services has posted a banner on its website that directs people to information on the Medicaid changes, while Iowa has a dashboard on its website that provides important Medicaid information.
Both said that they’re using social media, email, and contacts with health care providers, vendors, and local government offices to get information to affected Medicaid enrollees. Garcia said that her agency has even contacted a popular grocery store chain, Hy-Vee, that has stores in many rural areas.
“It’s in every small town in Iowa. So we spend a lot of time talking with Hy-Vee, as they tend to be kind of a trusted ambassador of communication on the ground level in rural communities,” Garcia said.
Determining eligibility entails providing information such as addresses, employment status, and income, among other factors. Ineligible people can seek coverage through their state’s health insurance marketplace, purchase a private policy, or check into group insurance through their work.
The main reasons for ineligibility are income or the recipient already having coverage.
Blase said that disenrolling ineligible people makes resources available for those who genuinely need them. It can also free up tax money for other needs or reduce the taxpayers’ burden.
Iowa and Arkansas started reviewing their rolls in April.
Garcia said that 80 percent of those removed from the Medicaid rolls in April and May already had health insurance. So far in June, she said, it’s 34 percent. The webinar hosts pointed out that there are protections for people who are disenrolled incorrectly.
Blase said that hospitals operate on the concept of presumptive eligibility. This means that a person can apply for coverage when they arrive for treatment, and the hospital will provide care based on the idea that they’re eligible.
Medicaid also offers retroactive eligibility. Under this procedure, one can apply for Medicaid at the time of treatment. If that person is eligible, Medicaid will cover that treatment plus any care from the previous three months.
Finally, if one is determined to be ineligible, that decision can be appealed.
Some Subsidies Will Remain
According to the Congressional Budget Office (CBO), the number of people covered under Medicaid and Medicare reached historic highs in May. This is mainly due to policies put in place during the pandemic.Those policies provided increased funding to states that didn’t cull their roles of ineligible recipients for at least three years.
All states have been instructed to develop plans to reduce the rolls in line with the decreased funding by removing ineligible beneficiaries. According to PHI, Oregon is expected to be the last state to complete the thinning of its rolls by October.
The end of the pandemic subsidies doesn’t mean the end of all subsidies.
“Medicaid enrollment grew from 60.5 million in 2019 to 76.6 million in 2022. In 2023, Medicaid covers 28.1 percent of the under-65 population, and subsidized marketplace plans cover 5.2 percent. Employment-based insurance covers more than half (57.3 percent) of that population,” according to a May 24 statement on the CBO website.
The CBO reported that 2023 federal health care subsidies for people under 65 totaled more than $1 trillion. That’s expected to grow to about $1.6 trillion by 2033 annually, the CBO said. This comes to about 4 percent of gross domestic product.
“Over the 2024–2033 period, subsidies are projected to total $12.5 trillion,” the CBO website states.
Employment-based coverage will account for 40 percent of the subsidies, with the remainder divided among Medicaid and the Children’s Health Insurance Program, at 39 percent; Medicare, at 13 percent; and insurance from the marketplaces or the Basic Health Program, at 8 percent, according to the CBO’s projections.
