In recent weeks, hundreds of thousands of Americans with low incomes have lost Medicaid as part of the unwinding of an old policy from the pandemic era that prohibited states to remove people from this program.
Early data indicates that many people have lost their coverage due to procedural reasons. For example, Medicaid recipients who could not be found or did not return the paperwork required to confirm their eligibility. Many people are losing coverage because of procedural reasons. Many of the people who were dropped are children.
A provision of a 2020 coronavirus relief package that Congress passed prohibited states from terminating Medicaid coverage at any time during the pandemic. The continuous coverage guarantee spared people regular eligibility checks and boosted Medicaid enrollment to record levels.
The policy ended at the end March. This set in motion a massive bureaucratic effort across the nation to verify who is still eligible for coverage. States have released data in recent weeks on who lost coverage and for what reason. This gives a glimpse at the toll the unwinding has taken on the most vulnerable and poorest Americans.
At least 19 states are currently removing people from the rolls. It is still unknown how many people lost their coverage.
At the end of March, Arkansas had more than 1.1m people on Medicaid -- nearly a third the population. Around 73,000 people, including 27,000 children under 17 years old, lost their coverage in April, the month when states were allowed to begin removing people.
Melissa Buford was dropped from the plan. She is a diabetic and has high blood pressure. She makes around $35,000 per year working at a clinic in Eastern Arkansas that helps families find affordable insurance. Her two adult children also lost coverage.
Ms. Buford's income increased, and she was no longer qualified for Medicaid. She was so angry when she got a notice telling her she didn't qualify that she threw the letter in the trash.
Most of the people who were denied coverage in Arkansas did so for procedural issues.
Daniel Tsai is a senior official with the Centers for Medicare & Medicaid Services, who oversees the unwinding for the Biden Administration. He said that there was a need for more outreach to those who had lost their coverage. He said that federal officials are in constant contact with state officials across the country, reviewing early data about the unwinding process and checking whether those who lost coverage have a fair chance to prove their eligibility.
Sarah Huckabee Sanders, a Republican from Arkansas, has described the unwinding process as a necessary one that will save money while allowing Medicaid to operate within its intended scope.
In an opinion piece published in The Wall Street Journal, Ms. Sanders stated that 'we're simply removing the ineligible from the program in order to keep resources for those in need and to follow the law'. She also said that "some Democrats and activist journalists oppose Arkansas’s actions because of their desire to keep people dependent upon the government."
Medicaid, which is jointly funded by the federal and state governments, has grown to be a major component of American safety net. In the first quarter of this year, more than one-fourth of Americans were enrolled in Medicaid, or the Children's Health Insurance Program. This is up from the 71 million who had been enrolled before the pandemic.
Arkansas's experience so far is indicative of the disruptions that will be caused in homes across the nation in the months to come. Americans may have to look for new insurance, or find a way to get Medicaid coverage they lost due to procedural issues. According to the federal government, 15 million people are expected lose their coverage. This includes nearly 7 million people who will be dropped even though they still qualify.
How the process will impact children is one of the most pressing questions. In Florida, a leukemia-free boy who needed a biopsy and was in remission lost his insurance coverage.
Before the dissolution, researchers at Georgetown University Center for Children and Families estimated that more than 50% of American children were covered by Medicaid and CHIP. Joan Alker is the executive director of the center. She said that many children who lose their coverage are dropped due to procedural issues, even though they may still be eligible.
She said, "These kids have no other option for coverage." Medicaid is the largest insurer of children. It is a huge issue for them.
Loretta Alexander, health policy director for Arkansas Advocates for Children and Families, said that in Arkansas, many children who lost Medicaid coverage were among the 'poorest of the poor'. She said that the loss of coverage would be particularly harmful to young children, who require regular developmental checks early in their lives.
The majority of states take around a full year to unwind Medicaid, and each state has its own method for removing individuals from the program. Arkansas passed legislation in 2021 that required officials to finish the process within six months. Gavin Lesnick is a spokesman with the Department of Human Services in Arkansas. He says that state officials check the eligibility of Medicaid-covered children early on because they are a significant portion of the enrolled population.
In her essay, Ms. Sanders referred to the Renew Arkansas campaign, which the state is running to inform residents of the unwinding.
She wrote: 'We hired additional staff and enlisted volunteer help.' We texted, called and emailed tens thousands Arkansans, who may now be ineligible to receive Medicaid. We also made an extra effort to reach those with disabilities, who had moved, who were suffering from cancer or dialysis, as well as pregnant women.
Local health workers, like Ms. Buford, are working to help people get coverage again if they qualify. She stated that she worked with between 50 and 75 Medicaid recipients in April who lost their coverage, helping them to fill out forms or answer their questions on how to verify eligibility.
In other states, a significant number of Medicaid recipients have been removed for procedural issues. Nearly 90 percent of Indiana's 53,000 Medicaid recipients who were kicked off in the first month after the state was dissolved did so for procedural reasons. Procedural reasons were the main reason for nearly 250,000 Medicaid recipients in Florida losing their coverage.
States are releasing different data on their progress, and they also have different strategies for removing people from Medicaid. This makes it difficult to compare the strategies at the beginning of the de-rolling process. "We are comparing apples, oranges and tangerines," Ms. Alker explained.
Some people will be able to obtain health insurance from their employers if they lose Medicaid. Other people will likely turn to the Affordable Health Care Act marketplaces to sign-up for private insurance. Many of them are eligible for plans that have no premiums.
Debra Miller, 54 of Bullhead City in Arizona, lost Medicaid in April when her salary of roughly $25,000 as a Burger King Cook made her ineligible. Ms. Miller is a single mom with diabetes and hypothyroidism. She worked with an insurance advisor at North Country HealthCare - a network federally funded clinics - to enroll in the marketplace plan that costs about $70 a month.
She said, "It's hard because I've never had a bill like this before." She added that her new plan does not cover vision insurance. This leaves her concerned about how she will pay for the eye appointments she requires as a diabetic.
Ms. Buford stated that the cost of Marketplace coverage for some Arkansas residents would be prohibitive.
She said, "You have a mortgage, a car and kids. You also need food." You don't really have enough money to pay for that much health insurance.
Ms. Buford explained that she was inspired to help others find health insurance when she saw her grandmother struggle with her medication and depend on food pantries. Ms. Buford attended a local community college to be able to care for her father who was in his 40s when he passed away. She said, 'I enjoy my job because it allows me to help others.'
After losing her Medicaid coverage, Buford expressed the hope that she would find a plan on the marketplace in a short time. She said that the family plan provided by her clinic is too expensive.
Buford stated, 'I am grateful for what I've got because others don't have it.' I just wish that I had kept my Medicaid.