Study: 15M people could lose Medicaid coverage after COVID-19 emergency ends

An estimated 15 million people could lose Medicaid insurance coverage after the COVID-19 public health emergency ends, according to a new study that sounds the alarm for states and the federal government to ensure enrollees have continuous coverage.

The Urban Institute’s study, released Wednesday and conducted on behalf of the Robert Wood Johnson Foundation, explores what would happen if key requirements to keep Medicaid recipients enrolled go away after the PHE, which is expected to run through the rest of this year. States will need to take action to ensure that affected residents know of other options for coverage.

“States can take actions to minimize unnecessary disenrollment and ensure that those losing Medicaid coverage know about their other coverage options, particularly [Affordable Care Act (ACA)] Marketplace coverage with premium tax credits,” said Matthew Buettgens, a senior fellow at the Urban Institute, in a statement.

A federal law passed last year prohibited states from disenrolling Medicaid beneficiaries through the duration of the PHE. The continuous coverage requirement is expected to increase Medicaid enrollment by an estimated 17 million people by the expiration of the PHE expected to happen after this year.

Urban found that the continuous coverage provision helped spur the ongoing Medicaid enrollment growth.

Typically, before the pandemic, people would lose eligibility and coverage and others would gain it.

“Over 21 months, eliminating the disenrollment caused by loss of eligibility translates into a substantial cumulative enrollment increase,” Urban’s study said.

States have a year after the end of the PHE to restore normal income eligibility requirements.

“More gradual processing of enrollment over 12 months could reduce unnecessary losses of coverage by allowing more time for planning and outreach,” Urban said. “However, the expected loss of the enhanced federal matching assistance percentage in March 2022 gives states a financial incentive to process enrollment more quickly.”

Urban estimates 15 million people will fall off the Medicaid rolls next year, including nearly 6 million children and 8.7 million adults.

Many of the people who could lose Medicaid will be eligible to get coverage elsewhere.

“Of the adults who would lose Medicaid, we estimate about a third would be eligible for [ACA] Marketplace premium tax credits if the enhanced tax credits in the American Rescue Plan Act were made permanent,” according to the study, referring to boosted credits that expire after the 2022 coverage year. Democrats in Congress are hoping to extend the credits in a $3.5 trillion infrastructure package.

It also found 57% of the children who would lose Medicaid coverage could get covered under the Children’s Health Insurance Program and another 9% could get ACA coverage with tax credits.

But “good coordination between state Marketplaces and Medicaid agencies is essential to reduce unnecessary losses of health coverage,” Urban said.