As states cut Medicaid, some fear they'll mistakenly end coverage for millions of eligible people
Tonya Moore, 49, relies on doctor visits and prescription drugs to manage her diabetes, chronic pain and high blood pressure.
But her access to routine care is now in danger. She is among tens of thousands of Arkansas residents poised to lose coverage under the state’s Medicaid health insurance program for low-income and disabled residents.
The federal government provided billions in federal aid to states on the condition that they wouldn’t remove people from Medicaid until the COVID-19 public health emergency ended.
Now, with legislation allowing cuts to resume April 1, the federal government estimates about 15 million people will be disenrolled from Medicaid coverage as states resume the eligibility checks that were paused during the pandemic.
But how quickly that happens depends on where you live.
“It’s very frustrating,” said Moore, who lives in Highland, Arkansas, and is unable to work because of a debilitating back injury. “I have no income coming in. It's not like I can pay for my medicine.”
The Biden administration said states can take up to one year to complete these checks, called redeterminations. Arkansas, Arizona, Idaho, New Hampshire and South Dakota will begin terminating Medicaid coverage this month.
Enrollment cuts will begin in May in Florida, Indiana, Iowa, Kansas, Nebraska, New Mexico, Ohio, Oklahoma, Pennsylvania, Utah, Virginia, West Virginia and Wyoming. All other states will start Medicaid cuts in June or July, except Oregon, which won't start until October.
Advocates warn states that accelerate this unwinding will make mistakes in what promises to be the largest bureaucratic lift in government health insurance coverage since the Affordable Care Act launched state Medicaid expansions a decade ago. The federal government estimates 8.2 million are no longer eligible, but 6.8 million could lose coverage even though they still qualify.
"We're very fearful that we could see the largest Medicaid losses in history, disproportionately hurting children and communities of color," said Stan Dorn, director of the health policy project at UnidosUS, the nation's largest Latino civil rights organization.
More than 5 million children are expected to lose coverage, and federal estimates project nearly 1 in 3 who lose coverage will be Latino and 15% Black.
"My big fear is that we're going to see an epidemic of paperwork terminations driven by needless red tape," he said.
Background: States prepare to remove millions from Medicaid
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States overwhelmed with 'paperwork terminations'
States that cut or reassigned staff when Medicaid eligibility checks were on hold are scrambling to prepare for the avalanche of mailings and paperwork. They'll have to process a huge number of renewal notices for existing enrollees while also handling new applications.
“Because of the sheer volume of work that all the state Medicaid agencies will have to embark on, people will inevitably fall through the cracks,” said Alicia Emanuel, senior attorney at the National Health Law Program, an advocacy group for low-income and underserved individuals.
She said renewal notices in some states have confusing language that is difficult to interpret. Rather than respond to confusing notices, Emanuel fears some enrollees might ignore mailings from state Medicaid officials.
Administrators will typically terminate coverage when someone doesn’t return paperwork, Emanuel said, even among those with disabilities who need help to respond or people who move frequently and might not get the notices.
Advocates for patients with disabilities also fear that their clients are at risk for terminations.
Many get Medicaid coverage if a disability limits their ability to earn income from work. Others qualify when a disability prevents a person from completing tasks on their own such as getting out of bed, eating or taking a shower, said David Goldfarb, a policy director at The Arc, an elderly care services company.
Though many are automatically eligible for coverage based on their disability, Goldfarb worries about disruptions as states complete mass terminations.
"Yes, they'll reapply, but there might be a crisis that (requires) hospitalization or institutionalization," Goldfarb said. "That disruption in care worries us."
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Arkansas accelerates Medicaid cuts
When the Biden administration allowed states to begin cutting enrollees beginning April 1, Arkansas was prepared.
In 2021, the Arkansas Legislature passed a bill that required the state to complete Medicaid eligibility checks within six months – half the time allowed by the Biden administration. It previously hired a contractor, Maximus, to process a backlog of pandemic applications that will stay to help the state complete the eligibility checks, according to the state's comprehensive unwinding plan.
The Arkansas Department of Human Services began sending notices in February to about 420,000 people whose coverage was extended during the public health emergency.
The state expects to verify income and other eligibility details and complete terminations by the end of September. Among the five states that will begin terminations this month, only Arkansas plans to complete them within six months. The other four states will take a year or so to complete the checks, according to a Kaiser Family Foundation survey.
Arkansas Medicaid enrollment increased to more than 1.1 million as of February, up from just over 900,000 in March 2020, according to Arkansas Department of Human Services. The state plans to report the number of initial Medicaid terminations by early May, said Gavin Lesnick, a Department of Human Services spokesman.
“I have no doubt, there’s going to be a lot of people caught in this,” said Loretta Alexander, a health policy director for the Arkansas Advocates for Children and Families.
In 2018, more than 18,000 people lost coverage when Arkansas attempted to implement a work requirement for people on Medicaid. In 2019, a federal judge put the work requirement on hold and the court restored coverage for most.
This year, however, Arkansas Gov. Sarah Huckabee Sanders pushed for reinstating the work requirement for able-bodied adults on Medicaid to "escape the trap of government dependency." The state must get a waiver approved from the Centers for Medicare and Medicaid Services.
While Alexander said the work requirement was chaotic, it was a small disruption compared to the thousands of residents poised to soon lose coverage.
“It can be a lot worse,” Alexander said.
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Moore learned this month that her Medicaid coverage was terminated when a provider called her and told her so, and she believes the state’s Medicaid program made a mistake.
Her 21-year-old daughter had two jobs while enrolled in college – one lasted a week, the other longer – since 2019. She and her daughter's coverage was terminated because of her daughter's past income, even though her daughter’s income did not affect Moore’s financial circumstances.
She called Legal Aid and has sent pay stubs from her daughter's former jobs and other documents to state Medicaid officials in hopes it will verify she’s still eligible for coverage she had for a decade.
But she’s out of medicine to lower her blood pressure and control her gastroesophageal reflux disease – and she can’t fill those prescriptions without insurance. She also takes prescriptions, metformin and Mounjaro, to control her diabetes.
If she is unable to afford the medications, she worries her health will worsen and potentially cause a serious medical complication.
"I just have to do without until my insurance kicks back in," Moore said.
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Health insurance options if for people who lose Medicaid coverage
Advocates say Medicaid recipients who get a notice of coverage termination still have options.
They can file appeals to the state Medicaid office to challenge the termination, an option many people on Medicaid don't realize they have, Alexander said.
Other options for health insurance: Department of Health and Human Services estimates about two-thirds of people cut from Medicaid can get health coverage through an employer, the military or other options.
Affordable Care Act Marketplace: The climate and health spending bill called the Inflation Reduction Act extended pandemic subsidies to make marketplace insurance plans more affordable, even to middle-income families. HHS estimates nearly 1.7 million people removed from Medicaid will be eligible for Affordable Care Act insurance plans with no monthly premium.
The challenge will be informing people they have other coverage options, said Matt Jewett, director of health policy at Children's Action Alliance in Phoenix.
Some who earn too much for Medicaid might be eligible for the Children's Health Insurance Program, for example. Or, they can get subsidized health insurance through the marketplace.
"It should not be on the people to figure out which category they are eligible for," Jewett said. "They ought to be able to apply in one place."
Ken Alltucker is on Twitter at @kalltucker, or can be emailed at alltuck@usatoday.com
This article originally appeared on USA TODAY: Amid Medicaid cuts, 6.8M people may mistakenly lose health insurance
