A pandemic-era rule that protected people from losing their Medicaid coverage will expire Friday, putting millions of peoples’ health insurance coverage at risk.
Medicaid provides free health insurance to people with low incomes.
Usually, Medicaid recipients need to renew their coverage every year, and if they are no longer eligible, they lose their coverage. But lawmakers passed a rule in 2020 that kept people automatically enrolled in the government program, even if they no longer met the requirements for coverage.
That protection will end Friday at midnight, leaving up to 15 million people at risk of losing their health insurance, according to an estimate from KFF, a nonprofit research organization formerly known as the Kaiser Family Foundation. Some 95 million people in the U.S. are currently enrolled in Medicaid and CHIP, which provides low-cost coverage to children, according to KFF.
Even a small gap in coverage can be “devastating,” said Jennifer Tolbert, the associate director for the program on Medicaid and the uninsured at KFF. Some may not be able to get access to their monthly medications, she said, while others may not get access to treatment for their chronic physical or mental health conditions.
The people most likely to be affected by the change are “children, young adults, Black and Hispanic or Latinx people,” according to Carrie Fry, a health policy professor at Vanderbilt University School of Medicine in Nashville, Tennessee.
“In sum, this is an all-hands-on-deck situation to minimize the number of people who lose Medicaid coverage,” Fry said.
What is happening?
Beginning Saturday, states will be allowed to begin “unwinding” — a process by which they will resume their annual Medicaid renewals and unenroll people who are no longer eligible for coverage.
Medicaid eligibility varies by state, but generally, people can qualify if their income falls below a certain threshold. In New York, for example, a single individual whose income falls under $19,392 annually before taxes or a married couple whose income is below $26,228 annually, can qualify for the program. Going even slightly above that cutoff could make a person ineligible for coverage.
People shouldn’t expect “a deluge of people” losing Medicaid coverage on Saturday, Tolbert said.
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, Tolbert said.
Eight states began sending renewal notices to Medicaid recipients in February, followed by another 15 states in March, Tolbert said. Despite the early start, no states are allowed to unenroll recipients until April 1.
Another 28 states are expected to begin the process in April. States must give enrollees at least 30 days to respond to a renewal notice and another 10 days following a notice of termination of coverage.
During this 12-month period, 5 million to 15 people are expected to lose Medicaid coverage, Tolbert said. The unenrollments will begin trickling in in April.
People whose income has increased are expected to be among those who lose coverage, she said. But 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, she added.
Why is this happening?
The continuous Medicaid coverage requirement was originally tied to the Covid-19 Public Health Emergency, which will expire in May.
In December, however, Congress passed the Consolidated Appropriations Act of 2023, which set a new end date for the Medicaid coverage rule of March 31.
Along with the new end date, states are required to attempt to contact enrollees prior to terminating their coverage.
The change is “disruptive,” said Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance in Massachusetts who advocates for health care reform.
Medicaid enrollment grew by 23.9% from 2020 to 2022 — an increase of 17 million people — according to a 2022 KFF report.
Many of the patients kicked off Medicaid will likely have “significant health needs,” Gaffney said.
What can people do?
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 said.
Tolbert said that if people have moved in recent months and haven’t notified Medicaid that their address has changed, they may need to check their previous address for the application. Others may have a language barrier and need assistance filling out the form.
Health systems, social service agencies, and community and faith-based organizations sometimes provide assistance to enrollees on updating Medicaid applications, Fry added.
People who lose Medicaid coverage will be eligible to purchase coverage under the Affordable Care Act, Gaffney said. The termination notice should provide instructions.
He noted the Inflation Reduction Act extended subsidies through 2025 for some people who buy individual coverage through the ACA.