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Millions of Americans are about to lose Medicaid coverage: Why is it happening?

Up to 15 million Americans are at risk of losing their health insurance coverage as a pandemic-era Medicaid rule expires on March 31, 2023. The rule, passed in 2020, allowed for automatic enrollment in Medicaid, even if recipients no longer met the coverage requirements. This ensured that vulnerable populations were not left without healthcare coverage during the pandemic. However, with the rule ending, states can begin annual Medicaid renewals and unenroll those who are no longer eligible.


Usually, Medicaid recipients need to renew their coverage every year, and if they are no longer eligible, they lose their coverage. Medicaid provides free health insurance to people with low incomes, and eligibility varies by state, but generally, people can qualify if their income falls below a certain threshold. Going even slightly above that cutoff could make a person ineligible for coverage.

The unwinding period is expected to last about 12 months, as states check everyone’s eligibility and send renewal and termination notices, although some states will do these checks faster than others. Despite the early start, no states are allowed to unenroll recipients until April 1. During this 12-month period, 5 million to 15 million people are expected to lose Medicaid coverage, according to Jennifer Tolbert, the associate director for the program on Medicaid and the uninsured at KFF, a nonprofit research organization formerly known as the Kaiser Family Foundation.


Increased demand for health insurance during the pandemic has seen Medicaid enrollment grow by 23.9% from 2020 to 2022, an increase of 17 million people, according to a 2022 KFF report. The end of the continuous Medicaid coverage requirement is expected to hit children, young adults, Black and Hispanic or Latinx people the hardest, according to Carrie Fry, a health policy professor at Vanderbilt University School of Medicine in Nashville, Tennessee.

Even a small gap in coverage can be “devastating,” says Tolbert. Some may not be able to get access to their monthly medications, while others may not get access to treatment for their chronic physical or mental health conditions. People whose income has increased are expected to be among those who lose coverage. However, people who are still eligible but did not provide information that their state needs to confirm — like income or current residence — are also expected to lose their insurance, says Tolbert.


States will terminate Medicaid coverage if a person does not complete the renewal application by the state’s deadline. People with Medicaid should make sure their addresses are up-to-date, keep an eye out for Medicaid application materials in the mail or via email, and complete the renewal application by their state’s due date, Vanderbilt’s Fry says. Health systems, social service agencies, and community and faith-based organizations sometimes provide assistance to enrollees on updating Medicaid applications, Fry added.

Despite the potential loss of healthcare coverage, some believe that there is a silver lining. Unenrollment from Medicaid means that people who have seen an increase in their income may be able to purchase coverage under the ACA, says Gaffney. Furthermore, the Inflation Reduction Act extended subsidies through 2025 for some people who buy individual coverage through the ACA.



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