KFF: Up to 14M enrollees could lose Medicaid coverage as states restart eligibility checks

Between 5.3 million and 14.2 million enrollees could lose Medicaid coverage next year as the Biden administration is expected to roll back the program’s continuous coverage provision, a new analysis finds. 

The analysis, released Tuesday by the Kaiser Family Foundation, explores how much enrollment in Medicaid changed during the pandemic, including the impact of a requirement that could go away that prevented states from disenrolling recipients. It also found that a boost in federal funding helped to cover the costs of new enrollment for states.

“As states resume redeterminations, it is likely that there could be a lot of enrollment churn as individuals who may be eligible lose coverage and then re-enroll in a short period of time,” the analysis said. 

At the onset of the pandemic in 2020, the federal government increased the matching rate for Medicaid by 6.2% to states that met certain requirements. Chief among those stipulations is states cannot disenroll anybody on Medicaid until the end of the COVID-19 public health emergency, which was recently extended through July. 

If the PHE is not extended again, states will have to begin the massive task this summer of redetermining who is eligible or not for Medicaid coverage. The analysis lays out the stakes for states on in terms of how many people could drop off. 

Kaiser estimated that Medicaid enrollment will grow by 25% from 2019 through the end of the 2022 federal fiscal year, which ends in September, representing a spike of 22.2 million people. The foundation looked at simulation models that relied on Kaiser estimates of Medicaid enrollment.

Of that 22.2 million, 3.5 million will be from baseline growth and another 18.7 million from the continuous coverage requirement. 

It is difficult to pin down an exact figure on how many Medicaid beneficiaries could lose coverage after redeterminations begin. 

“The effects by eligibility group will depend on how states prioritize renewals once the continuous coverage requirement ends,” Kaiser said. “Additionally, individuals could be at risk of losing coverage even if many continue to be eligible due to barriers navigating the redetermination process.”

Some groups that saw major boosts in enrollment—such as children and adults from Medicaid expansion states—could see the largest losses though.

“Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage,” Kaiser added.

The foundation also looked at the amount of funding states got via the enhanced match. Kaiser estimated states got approximately $100 billion in relief from the boosted funding, more than double the total estimated costs states have faced from the additional enrollment from 2020 through 2022.

The higher matching rate provided “relief to stats using an existing federal funding mechanism, which has allowed money to be distributed quickly and freed up state funds for other purposes, including the ability to support Medicaid and fill gaps in overall state budget shortfalls,” the analysis said.

The Centers for Medicare & Medicaid Services has given states guidance on how to handle redeterminations and states have up to 14 months to perform such redeterminations. The Department of Health and Human Services has promised to give a 60-day notice on when the PHE will end, and that notice could come as early as next week.