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medicaid purge
Wyden Says GOP Medicaid Purge Puts 'Politics Before Children's Health'
New government data indicates that just nine Republican-led states are responsible for 60% of Medicaid and Children's Health Insurance Program disenrollments since April.
Dec 19, 2023
U.S. Sen. Ron Wyden ripped GOP governors on Monday for endangering the well-being of kids in their states for political purposes as they gut their Medicaid and Children's Health Insurance Program rolls at an alarming clip, sparking pushback from the Biden administration and healthcare advocates.
"Unfortunately, it's clear that too many Republican governors have chosen to put politics before children's health," Wyden (D-Ore.), chairman of the Senate Finance Committee, said in a statement after the U.S. Department of Health and Human Services (HHS) released new data showing that a small handful of GOP-led states account for the majority of Medicaid and CHIP disenrollments since April.
That month, the federal government began allowing states to resume eligibility checks and disenrollments that were paused during the Covid-19 pandemic. The health policy nonprofit KFF has estimated based on available data that 71% of those kicked off Medicaid across the U.S. since April have lost coverage for procedural reasons, such as a paperwork error.
Wyden said it's "encouraging" that HHS is giving governors "the opportunity to do right by the families they cover" and pledged to work with President Joe Biden's administration to "ensure everything possible is done to protect coverage for families walking an economic tightrope."
According to the HHS analysis, nine Republican-led states are responsible for roughly 60% of Medicaid and CHIP disenrollments this year: Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota, and Texas. Additionally, HHS said the 10 states that have not expanded Medicaid under the Affordable Care Act "have disenrolled more children than those that have expanded combined."
"States must take bold action to prevent a large increase in their uninsured child population. Three million losing Medicaid and counting is a terrible way to ring in the new year."
In letters to the nine states' GOP governors, HHS Secretary Xavier Becerra urged them to "ensure that no child in your state who still meets eligibility criteria for Medicaid or CHIP loses their health coverage due to 'red tape' or other avoidable reasons as all states 'unwind' from the Medicaid continuous enrollment provision that was in place during much of the Covid-19 public health emergency."
"HHS takes its oversight and monitoring role during the renewals process extremely seriously," Becerra added, "and will not hesitate to take action to ensure states' compliance with federal Medicaid requirements."
Becerra suggested a few strategies aimed at improving the states' often byzantine renewal processes, including boosting auto-renewals and engaging in more active outreach efforts to make sure families know how to keep their coverage.
At least one state leader, Republican Gov. Sarah Huckabee Sanders of Arkansas, signaled she has no intention of acting on Becerra's recommendations.
"The failing Biden admin sent letters to GOP-led states in a politically motivated PR stunt, accusing us of restricting Medicaid access. That's false," Sanders, who served as former President Donald Trump's press secretary, wrote on social media in response to Becerra's letter. "Arkansas is in compliance with state and federal law, while Biden plays politics at Christmas."
Arkansas has worked aggressively to curb its Medicaid rolls this year, stripping more than 427,000 people of coverage in just six months. In September alone, more than 21,000 people were removed from the program for not returning their enrollment paperwork, according to state data.
The nationwide Medicaid purge that began in April has been described as "the largest concentration of health insurance loss in American history," and both Republican governors and the Biden administration have faced criticism for failing to prevent disaster.
Georgetown University's Center for Children and Families (CCF) estimates that, as of Monday, more than 3 million children have been disenrolled from Medicaid since eligibility checks resumed in the spring.
"In 2022, 3.9 million children were uninsured, so even if the majority of children losing Medicaid have other sources of coverage, the number of uninsured children is rising sharply," CCF executive director Joan Alker wrote in a blog post on Monday. "States must take bold action to prevent a large increase in their uninsured child population. Three million losing Medicaid and counting is a terrible way to ring in the new year."
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North Carolina Shows States Can End the Great Medicaid Purge—and So Can the Federal Government
Avoiding this catastrophic loss of healthcare coverage is the first step in protecting the well-being of the most vulnerable among us.
Aug 07, 2023
In what’s being cited as an “unusual move, ” North Carolina Governor Roy Cooper (D) is expanding Medicaid in the state this October in advance of funding approval, pressuring Republican leaders to fund Medicaid expansion on its own or pass a budget.
Gov. Cooper’s decision is not an unusual move - it’s the right move and more states should follow his lead. At least one million people have already lost Medicaid coverage due to the end of the COVID-19 Public Health Emergency (PHE) Continuous Medicaid enrollment policy, pushing an already-vulnerable population down a path of widening disparities and disruptions in care. Black and Latino individuals make up over 39% of those predicted to be ineligible for Medicaid and over 48% of those predicted to lose coverage due to administrative barriers.
Researchers like myself are gearing up to meticulously study the numerous impacts of this “Great Mass Medicaid disenrollment” and expect findings to trend in a negative direction.
Individual financial health and equity gaps will worsen as medical debt increases. Providers in rural areas and those serving low-income populations will be more likely to close shop, reducing access to care.
Medicaid is a public health insurance program, jointly financed by the federal and state governments, that currently covers 86 million low-income individuals. Eligibility differs by state and is based on the federal poverty level.
To minimize Medicaid disenrollment, the Federal government will gradually phase down the 6.2% payment increase in states that comply with Federal rules including eligibility standards, conducting renewals, and insurance premiums. On the state level, infrastructure, capacity, and political appetite vary widely, affecting the number of people who lose Medicaid coverage due to cumbersome administrative burdens. Ironically, the same federal government that ended the Medicaid continuous enrollment is also providing financial incentives for states to expand Medicaid programs and urging states to adopt all available options to “ensure that individuals do not lose coverage due solely to administrative processes.”
Medicaid expansion is high on the list of what states can do to protect thousands of individuals. Currently, 10 states have not expanded Medicaid programs, despite the Federal government covering 90% of associated costs. This is well above the average Federal match for the traditional Medicaid population that ranges from 50% to 77%. Additionally, states can extend Medicaid postpartum coverage to 12 months and implement 12 months of continuous enrollment for children.
States could also automate processes for eligibility renewals and strengthen outreach campaigns. Ex parte renewals (passive or automated renewals) are processed based on the enrollee’s previous information and other electronic data sources including the Social Security Administration, Equifax’s Work Number, and the Supplemental Nutrition Assistance Program.
Additionally, outreach campaigns in different languages can protect individuals with Limited English Proficiency who are more likely to experience administrative challenges when renewing Medicaid coverage. During my time working as a tri-lingual Medicaid enrollment specialist for a large safety-net hospital system, our community-wide multilingual campaigns were critically important in protecting vulnerable individuals during the largest healthcare reform in Massachusetts.
For the 8.2 million individuals who will lose Medicaid coverage due to ineligibility, states can improve transitions from Medicaid to marketplace private health insurance coverage by implementing auto-enrollment into marketplace plans similar to California and Rhode Island’s models. States can also establish a “basic health program”, as in New York and Minnesota, which are more affordable options compared with marketplace plans.
The current Great Mass Medicaid disenrollment will dig its heels into the necks of individuals who are low-income, homeless, racial minorities, live in rural areas, and have limited English proficiency. Avoiding this catastrophic loss of healthcare coverage is the first step in protecting the well-being of the most vulnerable among us.
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15 Million People Could Lose Coverage as Nightmarish Medicaid 'Purge' Begins
"I feel sick," said one physician. "Medicaid is not enough: we need seamless, lifelong universal care now."
Apr 01, 2023
Beginning on Saturday, states across the U.S. will start the process of stripping Medicaid coverage from millions of people as pandemic-related protections lapse, part of a broader unraveling of the safety net that was built to help families withstand the public health crisis and resulting economic turmoil.
Medicaid's continuous coverage requirements were enacted early in the Covid-19 pandemic to help vulnerable people maintain insurance amid the health emergency, resulting in record-high Medicaid enrollment.
But at the end of last year, congressional negotiators agreed on a bipartisan basis to set April 1 as the beginning of the "unwinding" process for the continuous coverage mandates, which prevented states from conducting regular eligibility screenings for Medicaid recipients.
The bipartisan deal gave states 12 months to determine who is still eligible for Medicaid, but some states—including Arkansas and South Dakota—are jumping at the opportunity to quickly remove people from the program. (State timelines for kicking off the unwinding process can be seen here.)
"Tonight at midnight some people in AZ, AR, ID, NH, and SD will lose their Medicaid coverage," Joan Alker, executive director of the Georgetown Center for Children and Families, tweeted Friday. "South Dakota is especially vexing as expansion kicks in July 1st. The state could structure their renewals to ensure that parents move seamlessly into expansion. But they are erroneously claiming federal rules mean they can't. Not true."
Residents of the 10 states that have refused lifesaving Medicaid expansion under the Affordable Care Act (ACA) are likely to be hit hardest by the end of continuous coverage requirements, which the Biden administration estimates could result in 15 million people losing health insurance nationwide—including millions of children.
"Because those states tend to make only the extremely poor eligible for Medicaid, they will have many people who make too much to qualify for the government health insurance but not enough to reach the income needed to get federal subsidies to afford health plans sold on ACA marketplaces—the coverage the administration is counting on as the main fallback," The Washington Post's Amy Goldstein reported earlier this week.
"The toll will be large, too, in 13 states that have not chosen to extend Medicaid benefits to women for a full year after they give birth," Goldstein added. "Texas falls on both lists."
Because of the administrative barriers associated with income verification and other eligibility tests, many people are likely to lose Medicaid coverage even though they're still eligible for the program.
The Health and Human Services (HHS) Department has estimated that nearly 7 million people could be removed from Medicaid despite still being eligible due to "administrative churning."
The consequences of what one commentator has dubbed "The Great Medicaid Purge" could be disastrous, given the health impacts associated with insurance loss.
As HHS summarized in a recent report:
People who experience churning or coverage disruptions are more likely to delay care, receive less preventive care, refill prescriptions less often, and have more emergency department visits. One study found that unstable Medicaid coverage increased emergency department use, office visits, and hospitalizations between 10% and 36% and decreased use of prescription medications by 19%, compared to individuals with consistent Medicaid coverage. Children with interruptions in coverage also are more likely to have delayed care, unmet medical needs, and unfilled prescriptions.
"I feel sick," said Adam Gaffney, an ICU doctor at the Cambridge Health Alliance. "Some 15 million people will be purged from Medicaid, including 7 million who actually remain eligible for the program but fail to jump through the bureaucratic hoops! Medicaid is not enough: we need seamless, lifelong universal care now."
The Medicaid continuous coverage requirements are the latest pandemic-era protections to fall in recent months.
Starting on March 1, enhanced Supplemental Nutrition Assistance Program (SNAP) benefits were cut off in dozens of states, slashing food aid for tens of millions.
Additionally, the boosted Child Tax Credit (CTC) expired in late 2021 due to opposition from Sen. Joe Manchin (D-W.Va.) and congressional Republicans, resulting in a rapid surge in child poverty. Shortly before the expanded CTC lapsed, boosted unemployment benefits that helped millions weather economic chaos ended.
As the pandemic-era safety net crumbles, congressional Republicans are looking to roll back Medicaid, SNAP, and other key programs even further with spending cuts and punitive work requirements.
"Republican calls to cut government funding put everything from child care to opioid treatment and mental health services to nutrition assistance at risk for millions," Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, warned earlier this week.
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