In recent months, Medicaid coverage has been terminated for over 1 million individuals as certain states swiftly discontinued their health care support following the conclusion of the COVID-19 pandemic.
The majority of these individuals were removed from the program due to failure to complete necessary paperwork.
Although the federal government mandates an eligibility review, the administration of President Joe Biden has expressed concerns about the expeditious manner in which some states are handling the process.
Publicly available reports and data obtained by The Associated Press reveal that over 1.5 million people have already been taken off Medicaid in more than two dozen states that initiated the review in April or May.
Among the states, Florida has witnessed the largest number of individuals being dropped, amounting to several hundred thousand. Other states have also experienced notably high termination rates. In states such as Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah, and West Virginia, around half or more of the individuals whose cases were evaluated in May were removed from the program.
According to its own records, Arkansas has discontinued Medicaid coverage for over 140,000 individuals.
The eligibility redeterminations have caused difficulties for Jennifer Mojica, a 28-year-old who received notification in April that she no longer qualified for Medicaid due to an incorrect determination by Arkansas regarding her income exceeding the limit.
Although she resolved her own eligibility issue, Mojica faced another setback when she was informed that her 5-year-old son would be removed from Medicaid because she had supposedly requested his cancellation—a request she claims she never made. While her son’s coverage has been reinstated, Mojica has now been informed that her husband is no longer eligible. The constant uncertainty surrounding their Medicaid coverage has been incredibly frustrating for her.
Mojica expressed her exasperation, stating, “It was like fixing one thing and then another problem came up, and they fixed it and then something else came up.”
Officials in Arkansas have made efforts to automatically renew coverage for as many individuals as they can, with a particular focus on reaching families with children. However, due to a state law enacted in 2021, which mandates the completion of eligibility redeterminations within six months after the pandemic, the state will continue to promptly disenroll individuals who are deemed ineligible, as stated by the Department of Human Services.
Arkansas Governor Sarah Huckabee Sanders has responded to criticism of the state’s process by dismissing it. In a tweet last month, she stated, “Those who do not qualify for Medicaid are taking resources from those who need them. But the pandemic is over — and we are leading the way back to normalcy.” Governor Sanders maintains that individuals who do not meet the eligibility criteria for Medicaid should not receive resources that should be directed towards those who truly require them. She emphasizes that Arkansas is taking steps to restore normalcy in the aftermath of the pandemic.
As of the most recent data available in February, over 93 million individuals across the country were enrolled in Medicaid. This number represents an increase of nearly one-third compared to the pre-pandemic total in January 2020. The significant rise in enrollment was due to federal laws that prohibited states from removing individuals from Medicaid during the health emergency. In return, states received increased funding.
With the resumption of eligibility reviews, states have started addressing a backlog of cases to assess whether there have been changes in people’s income or life circumstances. States have been given a year to complete this process. However, locating and obtaining responses from everyone has proven challenging. Some individuals have moved, changed their contact information, or ignored mailings related to the renewal process.
The Florida Department of Children and Families, for instance, stated that it makes multiple attempts to contact individuals before removing them from Medicaid. These attempts include text messages, emails, and phone calls. Despite these efforts, the department reported that 152,600 individuals have been non-responsive.
The option to restore coverage retroactively exists if individuals submit information demonstrating their eligibility within 90 days after their deadline.
Unlike some other states, Idaho continued to assess Medicaid eligibility during the pandemic without removing anyone. When the enrollment freeze ended in April, Idaho began reviewing these cases, resulting in the removal of nearly 67,000 out of the 92,000 individuals whose cases have been decided thus far.
Hillarie Hagen, a health policy associate at the nonprofit Idaho Voices for Children, noted that there is still significant confusion among families regarding the ongoing changes. She expressed concern that individuals may visit healthcare providers in the coming months unaware that they have lost their Medicaid coverage.
Advocates worry that many households losing coverage may include children who are actually still eligible. Medicaid covers children at higher income levels compared to their parents or guardians. A report by the U.S. Department of Health and Human Services last year predicted that children would be disproportionately affected, with over half of those disenrolled actually remaining eligible.
However, confirming this disparity is challenging because the federal Centers for Medicare & Medicaid Services (CMS) does not require states to report a demographic breakdown of those dropped. In fact, CMS has yet to release any state-by-state data. The data obtained by The Associated Press was acquired directly from states and other organizations collecting such information.
Recipients of Medicaid in various states have described the eligibility redetermination process as frustrating. Julie Talamo from Port Richey, Florida, shared her experience of calling state officials every day for weeks, spending hours on hold, to ensure her 19-year-old special-needs son, Thomas, would maintain Medicaid coverage. While she anticipated her own coverage ending, she was shocked to learn that her son’s coverage would be shifted to a different program that could require her family to pay $2,000 per month. Eventually, an activist connected Talamo with a senior state healthcare official who confirmed her son’s continued eligibility for Medicaid. Talamo criticized the haphazard process, stating that the system was designed to fail people.
Several states have struggled to complete all the required eligibility determinations each month. Pennsylvania reported over 100,000 incomplete cases in both April and May. Similarly, tens of thousands of cases remained incomplete in April or May in states such as Arizona, Arkansas, Indiana, Iowa, New Mexico, and Ohio. Tricia Brooks, a research professor at the Georgetown University Center for Children and Families, expressed concerns that if states are already falling behind in processing renewals, the backlog will continue to grow over time, making it challenging to catch up easily.
One individual still uncertain about their Medicaid coverage is Gary Rush, a 67-year-old resident of Pittsburgh. In April, he received a notification that he would lose his Medicaid coverage due to his retirement accounts, even though he doesn’t withdraw from them. With the assistance of an advocacy group, Rush appealed the decision and was given until July to reduce his savings by approximately $60,000. However, he is concerned about the potential loss of coverage for his diabetes medication, which costs around $700 per month, considering he only receives $1,100 monthly from Social Security.
In Indiana, Samantha Richards, 35, has been on Medicaid her entire life and currently holds two part-time custodian jobs. Earlier this year, she received a letter informing her that the pandemic-era Medicaid protection would end. With the help of a local advocacy group, she managed to navigate the renewal process, but she remains apprehensive. Richards expressed concerns about the unpredictability of Medicaid, fearing the possibility of receiving a letter stating that she must reapply due to missing paperwork or deadlines. She also worries about arriving at a doctor’s office or pharmacy only to discover that her insurance didn’t go through.
This article was reported by Lieb from Jefferson City, Missouri, and DeMillo from Little Rock, Arkansas. Contributions were also made by AP reporters Anthony Izaguirre in Tallahassee, Florida; Marc Levy in Harrisburg, Pennsylvania; and Arleigh Rodgers in Bloomington, Indiana. Rodgers is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.