While the predicted large-scale disruption in Medicaid coverage has been dramatically validated in the past year, people who’ve been affected have options to minimize or even avoid the risks of a coverage gap.
More than 16 million people enrolled in the program have lost their coverage as of Feb. 1, according to a report from the nonprofit health policy group KFF. The results come as states continue a yearlong process to requalify all people covered by Medicaid as part of “unwinding” provisions that rolled out during the COVID-19 pandemic.
The number of disenrollments makes up one-third of the nearly 49 million eligibility reviews completed so far, the KFF report shows. And that number includes more than 3 million children. According to medicaid.gov enrollment data, just over 87 million people were enrolled in the joint state-federal health insurance program in April 2023, when the unwinding process began.
With more reviews to come in the months before states complete the requalifications, millions of people could face disenrollment and the harms of a Medicaid coverage gap, like having to take on medical debt or dealing with declining health.
If you’re worried about a coverage gap, it can help to understand the requalification process and systemic problems with Medicaid’s eligibility redeterminations. Plus, there are steps you can take to regain or maintain coverage.
Paperwork issues account for most disenrollments
The yearlong “unwinding,” which is about three-fourths complete, means that all enrollees must requalify for Medicaid benefits by demonstrating financial need and meeting other requirements.
The KFF report states that “across all states with available data, 71% of all people disenrolled had their coverage terminated for procedural reasons.”
Most of this loss of coverage is due to paperwork problems rather than because enrollees became ineligible due to an increase in their income or other changes in their circumstances.
In a procedural disenrollment, people are dropped from Medicaid because a renewal form wasn’t processed on time. Outdated enrollee contact information, the enrollee’s failure to submit a timely or complete application, and even a backlog in renewals processing are all reasons for procedural disenrollment.
Why does the renewal process fail for so many?
There are different perspectives on why so many millions of Medicaid enrollees have lost coverage because their paperwork didn’t go through.
“What has remained very challenging is enrollee response rates,” says Kate McEvoy, executive director of the National Association of Medicaid Directors. “Despite agencies reaching out through phone, text and email, many folks are not responding to the requests to provide additional information needed for eligibility redeterminations. In some cases that has meant there has been loss of coverage for otherwise eligible people.”
Allexa Gardner, a senior research associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, sees another side to the renewal issues.
“We’ve heard a lot more stories of someone being due for renewal and never getting their notice in the mail — again, not because the address on file is incorrect, but because there is some administrative issue, some USPS issue,” Gardner says. “We’ve heard about people mailing in or uploading their information and they are still disenrolled because the state has a huge backlog and is working to process renewals — but in the meantime sends a notice terminating coverage.”
Confusing notices leave many disqualified people in limbo
But even among people whose renewal applications Medicaid deems complete, problems remain — including disenrollment notices that are vague or baffling.
“Florida’s Medicaid notices are confusing,” says Sarah Grusin, a senior attorney with the National Health Law Program, a nonprofit advocacy group. “People who are disenrolled don’t really understand what’s happening or why, and they don’t know if the state has made a mistake. They don’t know whether to challenge the decision or what they need to prove to the state to maintain their coverage.”
In a 2023 class-action lawsuit against Florida, the National Health Law Program and Florida Health Justice Project represent two families who lost Medicaid coverage and were unable to get necessary medical care. One of the plaintiffs, puzzling over her 12-page Medicaid disenrollment notice, called a state agency to ask for an explanation of various confusing statements, including this one: “You are receiving the same type of assistance from another program.” The agent replied, “I have a rule that says I cannot talk to you for over 20 minutes,” according to the lawsuit.
How to maintain or regain Medicaid coverage
To avoid Medicaid coverage disruptions, Gardner says, “you have to do something because your eligibility will be rechecked every 12 months.”
Here are some ways to avoid frustration and loss of coverage, or to seek restoration of Medicaid coverage if you lose it.
Check your status and reapply if necessary. If you don’t know the status of your coverage, check it with your state Medicaid agency. Make sure the agency has all of your current contact information. If you’ve been dropped from Medicaid for financial or other qualifications, ask your state office for details and reapply for coverage as soon as you qualify. “People can at any point in time apply for Medicaid afresh and come back onto the program,” McEvoy says. “Unlike private insurance, you don’t have to wait for an open enrollment period.”
Use the reconsideration period. To get enhanced federal funding, states are required under certain circumstances to offer a reconsideration period of at least 90 days for parents and children if they are disenrolled because of a paperwork problem. During this period, procedurally disenrolled people can submit missing paperwork and have their coverage reinstated — retroactively for most people in most states — without having to repeat the entire application process. Check with your state agency to see if you’re eligible for the reconsideration period.
Create records of your application process. “Keep records of your communication with the state,” Grusin says. “If you are trying to upload a document and it won’t upload, take a screenshot. Keep fax receipts, keep a screenshot of the call log on your phone.” This documentation can form the basis for an appeal to your state Medicaid office.
Seek help from an advocate. Contact legal aid offices or community groups that provide Medicaid support services.
If you need to seek coverage elsewhere
If you no longer qualify for Medicaid, consider these alternatives.
Health insurance marketplace coverage. Apply for coverage through your state or federal marketplace. Many people who were recently disenrolled from Medicaid may be eligible for large premium subsidies.
Employer-sponsored insurance. Some people disenrolled from Medicaid are eligible for employer-sponsored coverage through their company or a family member’s employer. But the special enrollment window for such insurance typically is narrow — 30 days or less, according to Gardner. As with all the steps that you can take to avoid a coverage gap, time is of the essence.