Almost 90% of people expected to have gained Medicaid coverage during the COVID-19 pandemic could get dropped from the program once the public health emergency ends, a new report finds.
Federal law has prohibited states from kicking beneficiaries off of their Medicaid programs during the public health emergency. That, coupled with COVID-related job losses, has caused membership to remain higher than usual. However, 15 million new members risk losing coverage once the federal government ends its emergency declaration, researchers at the Urban Institute said in a report released Wednesday.
The report notes that more than 9 million nonelderly adults and children enrolled in Medicaid between February 2020 and January 2021. By the end of 2021, the researchers estimate enrollment will have grown by 17 million people compared with before the pandemic, bringing total Medicaid membership to 76.3 million.
Of the estimated 15 million people who could lose coverage, 8.7 million are adults and 5.9 million are children. The researchers estimate one-third of adults who lose coverage could qualify for subsidized private health insurance in Affordable Care Act marketplaces, and nearly all of the rest would have access to employer coverage in their families.
Of the children losing coverage, 57% would be eligible for the Children's Health Insurance Program, and another 9% would be eligible for subsidized coverage under the ACA.
State and federal policymakers will have to balance both Medicaid members' need to maintain coverage and the financial pressures facing state and local governments, Matthew Buettgens, a senior fellow at the Urban Institute, said in a statement on the findings.
"States can take actions to minimize unnecessary disenrollment and ensure that those losing Medicaid coverage know about their other coverage options, particularly marketplace coverage with premium tax credits," he said.
Last month, the Centers for Medicare and Medicaid Services said it would give states a full year after the public health emergency ends to finish redetermining eligibility for Medicaid beneficiaries, up from the previous six months. Stakeholders said the change would allow more time and flexibility.
The Urban Institute report notes that CMS could further help states by encouraging them to extend changes made to their programs during the pandemic. For example, some states could extend the changes they made to their disaster relief plans.
The report also urges Congress to maximize the number of people eligible for tax credits under ACA marketplace plans by making permanent the enhanced tax credits under the American Rescue Plan Act. It also says Congress should extend the enhanced federal match funds that go to states, known as federal medical assistance percentage, throughout 2022 so they aren't pressured to disenroll people. Enhanced FMAP is currently set to expire in March 2022.
Expanding access to Medicaid boosts health outcomes, particularly among communities of color and those with lower incomes, Avenel Joseph, vice president for policy at the Robert Wood Johnson Foundation, said in a statement. RWJF funded the report.
"Expanding access to affordable and comprehensive healthcare will significantly move the national closer to reducing long-standing racial and ethnic health disparities that were exacerbated by the pandemic," she said.