A new estimate finds that 18 million people could lose Medicaid coverage after the COVID-19 public health emergency ends, with 4 million becoming uninsured.
The analysis, conducted by the Urban Institute and released Monday, underscores the obstacles states and the federal government will face when the PHE ends and states must redetermine eligibility for those on Medicaid.
“We anticipate that the end of the PHE will cause the biggest changes in coverage since implementation of the Affordable Care Act more than a decade ago,” said Katherine Hempstead, senior policy adviser for the Robert Wood Johnson Foundation, which supported the study.
The report is the latest to detail the ramifications of the end of the PHE. Urban’s 18 million estimate is slightly above the 15 million the Department of Health and Human Services predicted will lose coverage.
The number of coverage losses is likely to continue to go up as long as the PHE persists and more people join Medicaid.
"This reflects the underlying dynamic of the PHE itself—enrollment keeps happening, but disenrollment does not,” said Hempstead in an email to Fierce Healthcare. “Normally, there is an inflow and outflow of members in every state’s Medicaid program as people gain and lose eligibility, even if net enrollment may grow or decline over time, but during the PHE the outflow is not taking place at anything like the normal level.”
At the start of the pandemic, the federal government raised the matching rate for Medicaid payments if the state agreed to not drop anyone off Medicaid’s rolls for the duration of the PHE. The emergency currently runs through January but is likely to be extended for another 90 days.
States have been preparing for months for the start of redeterminations, with some believing it could take at least a year to finish the task.
Urban relied on the latest Medicaid enrollment data as well as survey data on health coverage.
If the PHE ends in April 2023, 18 million people will drop off Medicaid over the next 14 months, the report said. Most of those people will transition to other insurance sources, with about 3.8 million people becoming uninsured.
It found that about 9.5 million people will get employer-sponsored care and more than 1 million will get Affordable Care Act coverage. Another 3.2 million children are also estimated to transition to the Children’s Health Insurance Program.
Researchers considered state policy issues that may affect the transition.
“First, some states could process enrollment more rapidly than others,” the report said. “The loss of the enhanced [federal matching Medicaid rate] in the quarter following the PHE expiration provides a financial incentive to do so.”
A faster redetermination process could result in millions more people losing coverage right after the PHE ends.
Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure has said coordination between states and the Affordable Care Act exchanges will also be pivotal to ensure people can get coverage via a special enrollment period.