Rolling Medicaid Purge
States across the U.S. have stripped nearly 6 million people of Medicaid coverage over just the past several months, creating what one healthcare activist and researcher described as "the largest concentration of health insurance loss in American history."
"This is happening in red states like Texas, Utah, or Idaho, where we expect this brutal Medicaid retrenchment," Beatrice Adler-Bolton, co-author of " Health Communism" and co-host of the popular "Death Panel" podcast, said in a statement on Friday.
"But there are huge amounts of procedural disenrollments happening in California. It's happening in Rhode Island and California and New Mexico," noted Adler-Bolton. "This is a year-long process, and it's just getting started. It's moving slowly, and it's more dangerous this way. This process is rolling, so the data is slow. We're not going to have a full picture of how to compare states against each other for months and months."
The latest data compiled by KFF—which includes publicly reported figures from 48 states and Washington, D.C.—shows that at least 5.7 million people have lost Medicaid coverage since April, when states began eligibility checks and disenrollments that were paused during the coronavirus pandemic.
A bipartisan deal reached by Congress and approved by President Joe Biden late last year lifted the pandemic-era continuous coverage requirements that prevented states from kicking people off Medicaid during the public health emergency. The policy led to record Medicaid enrollment, and its termination could cause upwards of 15 million people—including millions of children—to lose coverage under the program.
According to KFF, 73% of the people disenrolled from Medicaid so far have lost coverage for procedural reasons—such as a failure to return paperwork on time or jump through other, often confusing, bureaucratic hoops—not because they were deemed ineligible due to their income or other factors.
"High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage," KFF explained earlier this week. "Some states, such as Maine, have temporarily paused procedural terminations for some enrollees while the states address problems in the renewal process that lead to increased procedural disenrollments."
"Many of these individuals did not receive any notice of denial, leaving them unaware of their coverage termination."
Texas has removed more people from Medicaid than any other state, disenrolling around 617,000 in just a few months.
Late last month, the state's entire Democratic congressional delegation implored the Centers for Medicare and Medicaid Services (CMS) to intervene and ensure that Texas' Republican-dominated government complies with federal rules to "prevent the catastrophic loss of coverage."
The Democratic lawmakers, led by Reps. Lloyd Doggett and Greg Casar, cited a July whistleblower letter that issued dire warnings about Texas' Medicaid purge.
The whistleblowers, who identified themselves as employees of the Texas Health and Human Services Commission, wrote that roughly two weeks after the mass disenrollments began, "we started receiving numerous emails from agency leadership indicating that thousands of individuals had been erroneously denied coverage."
"As a result of the initial process we ran in April, we were informed that approximately 80,000 individuals lost coverage erroneously, including several thousand pregnant women who required critical services during their pregnancies or essential post-pregnancy care coverage," the whistleblowers wrote. "Additionally, we received subsequent emails from agency leadership indicating that several thousand elderly individuals were slated to lose medical coverage, which previously paid a portion of their Medicare Part B expenses."
"Many of these individuals did not receive any notice of denial," they added, "leaving them unaware of their coverage termination until their social benefits were reduced to cover the premium payments."
Shortly after the whistleblower allegations emerged, CMS sent letters to all 50 states noting that it had "learned of additional systems and operational issues affecting multiple states, which may be resulting in eligible individuals being improperly disenrolled."
One problem identified by CMS could be having a disproportionate impact on kids, the agency said in a statement.
"CMS believes that eligibility systems in a number of states are programmed incorrectly and are conducting automatic renewals at the family level and not the individual level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and [the Children's Health Insurance Program]," the agency said. "For example, children often have higher eligibility thresholds than their parents, making them more likely to be eligible for Medicaid or CHIP coverage even if their parents no longer qualify."
Speaking on the condition of anonymity, one Biden administration toldThe Washington Post that the number of children affected by the programming issue "is likely in the millions."
CMS has also warned that long call center times in at least 16 states could be causing people to give up on trying to renew their coverage.
While Republican-led such as Texas and Florida have moved aggressively to gut their Medicaid rolls, drawing outrage and lawsuits from residents, California, New York, and other blue states have also collectively removed hundreds of thousands of people from the program, often for procedural reasons—indicating a nationwide crisis.
Adler-Bolton warned Friday that "this is going to become the healthcare legacy of the Biden presidency" if his administration doesn't act quickly.
"When we look at [Affordable Care Act] enrollment expansion, 13 million people added in 2014. We're going to see a contraction of a similar amount—if not 10 million more—in the course of a calendar year," said Adler-Bolton. "CMS has the authority to halt procedural determinations today. We're only a few months into this and 74% are procedural determinations. CMS should be saying pause... It's their responsibility to do it."
Jake Johnson is a senior editor and staff writer for Common Dreams.