Skip to main content

HEADLINES: Nearly Four Million Americans Lose Medicaid Coverage Largely Due to Paperwork and Red Tape

By August 1, 2023No Comments

Republican-Led States Like Texas See Hundreds of Thousands Lose Coverage

Tracking from the Kaiser Family Foundation shows that nearly four million Americans have lost their Medicaid coverage as a result of the unwinding of the public health emergency requirement that states allow Medicaid enrollees to remain continuously enrolled in the program. In states reporting specific data, the majority of people who lost Medicaid were disenrolled due to bureaucratic red tape and paperwork requirements, and roughly one third of disenrollments were children. 

At the beginning of the COVID-19 pandemic, Congress passed legislation to ensure children and families counting on Medicaid would not be disenrolled during the public health emergency, but this provision expired on April 1. Experts fear that as many as 15 million people nationwide could lose their health coverage, disproportionately impacting children and people of color. It didn’t have to be this way — roughly three-quarters of those who have lost coverage so far have lost it due to administrative factors, not because they are now ineligible.

It’s no surprise that red states that have demonstrated hostility to affordable health care by refusing to expand Medicaid are among those who are racing to terminate Medicaid coverage.  The Republican-led states of Texas and Florida together have terminated coverage for over 900,000 Medicaid enrollees, and Georgia and South Carolina are among the top states with the highest rate of terminations for administrative reasons (rather than a verified loss of eligibility). Florida’s unwinding process is especially egregious: the state is the only state that has refused to adopt zero of the recommendations and flexibilities provided by the Centers for Medicare and Medicaid Service to help states minimize coverage losses. Instead of doing everything in their power to keep people covered, Republican governors like Greg Abbott, Brian Kemp, and Ron DeSantis are using this opportunity to slash their Medicaid rolls.

The Washington Post: Nearly 4 Million In U.S. Cut From Medicaid, Most For Paperwork Reasons. “[N]early 4 million Americans…have been lopped off Medicaid since the end of a pandemic-era promise that people with the safety-net health coverage could keep it, requiring every state to begin a herculean undertaking of sorting out who still belonged on the rolls. The 3.8 million — the most thorough tally — is an undercount, reflecting only people who have lost coverage so far in 38 states that have voluntarily made public their data from this sorting process, known as the Medicaid unwinding. Most of those people have been dropped from Medicaid for reasons unrelated to whether they actually are eligible for the coverage, according to KFF, a health-policy organization, which has been compiling this data. Three-fourths have been removed because of bureaucratic factors. Such ‘procedural’ cutoffs — prompted by renewal notices not arriving at the right addresses, beneficiaries not understanding the notices, or an assortment of state agencies’ mistakes and logjams — were a peril against which federal health officials had cautioned for many months as they coached states in advance on how best to carry out the unwinding.” [The Washington Post, 7/28/23]

  • Paperwork Issues Led To Arkansas Couple Losing Medicaid Coverage, Skipping Prescriptions. “The notice arrived in an envelope stamped ‘important information,’ telling Kristin Fortner she needed to prove that she and her husband still deserved Medicaid. She filled out the form within a week of receiving it this past winter and mailed it back. So she was perplexed by a phone call almost three months later from the Arkansas Department of Human Services alerting her that she had neglected to renew the couple’s Medicaid and, unless she sent the paperwork, their health insurance would end. Fortner quickly resubmitted the same form, this time in person. Except Arkansas already had cut them off. She discovered in May that her insurance had vanished as she tried to pick up a prescription for Suboxone, the medicine that helps her stay off opioids, from a Walgreens near her Fayetteville, Ark., home. Suddenly, she owed $380. Her Medicaid coverage, the pharmacy’s records showed, had expired April 30. A 33-year-old waitress earning $3 an hour plus tips, Fortner walked out of the drugstore without the pills.” [The Washington Post, 7/28/23]

AP News: Paperwork Problems Drive Surge In People Losing Medicaid Health Coverage. “The nation’s top health official implored states to do more to keep lower-income residents enrolled in Medicaid, as the Biden administration released figures Friday confirming that many who had health coverage during the coronavirus pandemic are now losing it. […] Though the federal government hasn’t released data from the most recent reports, information gathered by The Associated Press and health care advocacy groups show that about 3.7 million people already have lost Medicaid coverage. That includes about 500,000 in Texas, around 400,000 in Florida and 225,000 in California. Of those who lost coverage, 89% were for procedural reasons in California, 81% in Texas and 59% in Florida, according to the AP’s data.” [AP News, 7/28/23]

Texas Tribune: Texas Family Scrambles After Their Disabled Child Loses Medicaid. “Around 5 million Texans rely on Medicaid, which mainly provides health coverage for children, but some adults with disabilities and pregnant women can also receive benefits from it. The state intended to remove people who are now ineligible, including children who turned 18, aging them out of qualifying, and women months out of their pregnancies. But many eligible Texans have also lost coverage for reasons including procedural errors like not sending in renewal applications on time, jeopardizing their ability to access consistent care. But according to a letter addressed this week to the executive commissioner of the state agency that manages Medicaid for Texans, the Texas Health and Human Services Commission, approximately 80,000 eligible people have ‘lost coverage erroneously’. The letter, obtained by The Texas Tribune, was written by HHSC employees who did not name themselves, signing off only as ‘Concerned Texans and Dedicated Employees.’” [Texas Tribune, 7/28/23]

  • Medicaid Unwinding Revoked Life-Saving Treatments For A Texas Three-Year Old. “Jodi Whites glanced through tears in the rearview mirror at her 3-year-old daughter, Amelia, who was slumped in her car seat, pale-faced, lethargic and unresponsive. The 37-year-old mom of five repeated the same words loudly to her daughter as she tried to keep her awake. They were going to the hospital. They would figure it out. Everything would be fine. That day in April, emergency room doctors explained that an absence seizure, in which the patient is unresponsive, had caused Amelia to lose consciousness and start choking at school. They sent her home with medicine to prevent another. In the three months since, Amelia wakes up crying almost every hour of the night. Amelia presses and taps her hands on her forehead to try and calm down. Whites sleeps in Amelia’s room, feeling helpless beyond rubbing her daughter’s back or giving her another pillow to help her fall back asleep. […] But her daughter Amelia can’t see her doctors anymore. She can’t undergo scheduled brain tests because the Medicaid coverage that provided access to all her treatment — for her six congenital heart defects, her cerebral palsy and her autism — was revoked. Amelia is one of half a million Texans booted from Medicaid — the federal health insurance program for low-income individuals — after three years of continuous coverage during the pandemic, when federal regulations prohibited moving anyone off of the rolls.” [Texas Tribune, 7/28/23]
  • Medicaid Unwinding Is Leading To Bankruptcy, Home Foreclosure, Car Foreclosure, and More In Texas. “Terri Carriker, one of its board members, said Protect TX Fragile Kids has heard from dozens of families like the Whiteses going through the same situation since before the pandemic and she has seen families ‘file for bankruptcy, lose their homes, lose their cars and everything.’ The pandemic emergency rules allowed a break from feeling ‘on edge’ about the need to constantly requalify for coverage. Carriker’s own daughter has medical issues and has aged out of her own Medicaid waiver program and is now transferring to an adult waiver program. Waiver programs cover groups of people with specific sets of health needs so they can receive tailored health care. ‘My daughter would wind up in the hospital for something and I would almost feel relieved because at least here’s evidence that she still needs services,’ Carriker said. ‘It’s awful.’ […] Carriker said few other options remain for families in desperate need, but many are ‘stressful’ and ‘humiliating.’ One option includes taking a child for nursing home admission to one of the few facilities in the state that provide crisis care, and if the child meets multiple, strict health-related restrictions and spends one night in the nursing home, they can leave with Medicaid coverage.” [Texas Tribune, 7/28/23]

Georgia Recorder: More Than 63,000 Georgia Kids Lost Medicaid Access To Doctor Last Month Snared In Red Tape. “Children accounted for about two-thirds of the nearly 96,000 Georgians who lost their Medicaid coverage last month as part of the nationwide unwinding of a pandemic-era federal policy. And most of the children – 63,481 of them – had their health insurance terminated for procedural reasons, according to information provided by the state Department of Community Health in response to a request from the Georgia Recorder. […] Of the 67,454 total children whose Medicaid coverage was terminated last month, about 4,000 were ruled no longer eligible, according to the department’s data. But the state agencies responsible for the unwinding say some of the enrollees whose coverage was marked as being ensnared in a bureaucratic process were likely also no longer eligible. Information on file with the state suggested that about 20,000 of the 89,000 total adults and children who were disenrolled last month after not completing the renewal process in time would be ineligible for Medicaid today, according to DCH. For example, they may now earn too much money, live in another state or be too old for the state’s program for children. […] In Georgia, which has one of the highest uninsured rates in the country, as many as 545,000 people could lose their coverage, according to an estimate from last year. A significant number of Georgia children – 40% – are covered by Medicaid, according to Georgetown’s Center for Children and Families. Last month’s unwinding data represents the first large group of people to go through the process in Georgia, and it showed that more people lost coverage than kept it. When the state reported that monthly data earlier this month, the status of about 60,000 people was still pending – more than half of them children.” [Georgia Recorder, 7/31/23]

Missouri Independent: Missouri Kicked 32,000 Residents Off Medicaid In June. Half Were Kids. “More than 32,000 Missourians — half of them children — lost Medicaid coverage in June during Missouri’s first round of eligibility checks after the COVID public health emergency. According to a Department of Social Services announcement Thursday, out of the roughly 116,000 Medicaid recipients who had their eligibility checked in June, around 43% retained coverage, 28% lost coverage and 29% have their determinations pending. June was the first month of eligibility reviews as the state works through all of the roughly 1.5 million Medicaid enrollees on its books. About one-quarter of the state’s population is enrolled in Medicaid, the government health insurance program for low-income residents, called MO HealthNet in Missouri. As part of the federal government’s COVID relief measures, states were barred from removing Medicaid participants from their rolls in most cases from March 2020 to May 2023, regardless of whether they no longer qualified due to income or other eligibility limits. The public health emergency ended in May and states have begun the process of ‘unwinding’ the continuous coverage rule. In Missouri, the process will play out over 12 months, and then regular annual renewals will resume. The majority of those who lost coverage in June — around 72%, or 23,000 Missourians — were not directly found ineligible but were instead disenrolled because of what are called ‘procedural reasons,’ meaning the state was unable to determine whether they were eligible or not.” [Missouri Independent, 7/31/23]

Montana State News Bureau: More Than 34,200 Lose Medicaid Coverage In First 2 Months Of ‘Unwinding’. “Even more people were removed from Medicaid coverage in Montana during the second month of a massive process to re-determine the enrollment qualifications of everyone on the program. The pace of removals and data showing most of those who lost coverage ended up there because they failed to provide requested information to the state health department triggered two groups to ask the federal government to address their concerns and push the state to consider pausing or slowing the rate of the process called ‘unwinding.’ The state health department reported that 19,244 people were removed from Medicaid in May, compared to 14,960 in April when the unwinding started. That means nearly half of those in the first two rounds of reviewing coverage qualifications have lost their health insurance, or a total of 34,204 people. […] More than 64% of those who lost coverage did so not because the state determined they were ineligible, but because they failed to return information asked for by the Department of Public Health and Human Services. It’s unclear how many of those people would have remained qualified for Medicaid if they returned the paperwork. About a quarter of the population reviewed so far (that the state was able to gather information for) was determined ineligible for continued coverage. The unwinding process is set to take 10 months total.” [Montana State News Bureau, 7/28/23]

Paperwork Challenges Are Exacerbating Losses of Coverage From Medicaid Unwinding In Montana. “Marilyn Gomez, an eligibility specialist with All Nations, said many of her clients arrive to her confused about paperwork they’ve received, perplexed by the forms the state needs filled out or after learning their coverage was already terminated. ‘I’ve had multiple clients come in saying they verified their address and were waiting for paperwork in the mail and now in the month of June or July, they go to the pharmacy to pick up medications and they tell them you’re closed (meaning their coverage has ended),’ Gomez said. Other patients are waiting through the 45-day window for their reapplications to be processed after a denial. ‘If somebody’s diabetic and they need to get their medicine, I can’t tell them ‘Oh, Medicaid is pending but you can go get your insulin,’’ Gomez said. People can also be intim[id]ated by the sheer amount of information mailed to them, Gomez said, along with the process to apply online. There’s a dual-verification requirement to establish someone’s identity, and without a laptop or cellphone it’s not possible to submit. ‘A lot of the people I’m working with are not technologically savvy,’ Gomez continued. She had to get a work-issued smartphone to help people navigate the verification process, which requires the ability to take and submit a photo online.” [Montana State News Bureau, 7/28/23]