News

Apr 22, 2024

Millions of People Are Losing Health Care Because of Paperwork

The end of a pandemic-era rule requiring continuous Medicaid coverage is causing a slow-burning crisis. Across America right now, parents face a possible nightmare: taking a sick child to the doctor,

The end of a pandemic-era rule requiring continuous Medicaid coverage is causing a slow-burning crisis.

Across America right now, parents face a possible nightmare: taking a sick child to the doctor, only to be told at the front desk that their health insurance is no longer valid. The reason is that millions of low-income American families have lost Medicaid benefits because they have to jump through an unexpected administrative hoop, resulting in a slow-burning crisis.

The problem stems from the ending of a pandemic-era rule requiring states to maintain continuous Medicaid coverage for everyone on their rolls. Eligibility for Medicaid is primarily determined by income, and normally requires periodic verification. Now states have ceased providing continuous coverage. But that involves reestablishing the eligibility of all their enrollees in just six to 14 months, which means reaching a population that sometimes moves frequently because of housing instability and that hasn’t had to deal with the verification process since 2020.

The results have already been disastrous. As of August 3, the Kaiser Family Foundation, which tracks available state rolls, shows that nearly 4 million people have lost their Medicaid coverage. The numbers will continue to rise as verification checks roll along; government experts estimate that the final figure could be as high as 15 million. And among the eight states that currently break down disenrollments by age, nearly a third of those losing health care are children. This is particularly concerning and also not surprising: Many kids are eligible through either their parents’ Medicaid or a related child-specific program. As a result, about half of U.S. children are covered by one of these programs.

If everyone losing Medicaid were actually no longer eligible—perhaps they found a well-paying job after continuous coverage kicked in—this disenrollment would be less notable. However, among all the disenrolled in the states reporting their data, 74 percent have been dropped because of “procedural reasons.” The Kaiser Family Foundation defines these as situations where people simply did not complete the Medicaid renewal paperwork, perhaps because the state doesn’t have their current contact information, or they missed the deadline.

Many of the disenrolled are likely still eligible for coverage: One recent Kaiser Family Foundation survey of Medicaid recipients found that only 10 percent said they had a change that would make them ineligible for coverage, though an additional quarter said they were unsure. In some situations, individuals are losing coverage despite ticking all the right administrative boxes: The Texas Tribune reported that a letter written by unnamed employees of the Texas Health and Human Services Commission claims that nearly 80,000 eligible Texans have “lost coverage erroneously.” (The Texas HHSC did not confirm the number to the Tribune.) The same has happened in other places because of IT glitches or simply human error.

The human consequences have been serious—and could get worse. Parents are unable to afford needed medical care for their children; cancer treatments, surgeries, and other procedures risk being delayed. The unwinding debacle showcases the worst of government bureaucracy. As The Atlantic’s Annie Lowrey has written, “The issue is not that modern life comes with paperwork hassles. The issue is that American benefit programs are, as a whole, difficult and sometimes impossible for everyday citizens to use.” In this case, the challenge is also heightened by staffing shortages in many underfunded county and state Medicaid offices, as well as poor system design, which can limit automatic eligibility checks.

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The mass disenrolling also reflects partisan priorities, or lack thereof: The GOP pressed to hastily end continuous coverage, and both parties have systematically underfunded Medicaid infrastructure over the years. Although community groups are doing their best to reach affected families, the response from policy makers has been uneven. The federal Department of Health and Human Services, which oversees Medicaid, has offered states some additional flexibility and required a dozen states to briefly pause disenrollments to fix various issues. Otherwise, the department has made no move to force states to significantly slow down or change course on disenrollments, nor has Congress proposed any substantial legislative changes.

The stakes here are high: The simple failure to update one’s address or phone number—or a failure on the part of a state agency to properly process a form—is resulting in the loss of accessible health care for millions. Arguably few other current policy issues are more pressing for the well-being of low-income families and their children. And yet this entire situation feels like it should have been foreseeable—and avoidable.