Millions may lose Medicaid this year

A collaboration with the Daily Poster.

(Photo by Erik McGregor/LightRocket via Getty Images)

This story is being co-published with The Daily Poster.

Since the start of the pandemic, Medicaid, the federal and state program to provide health insurance to low income Americans, has been far more generous than in the past. Enrollment is higher than ever, at 77.8 million. 

This isn’t because of some nationwide change of heart in state governments; it’s because states were paid to stop cutting people from their Medicaid rolls. Under the Families First Coronavirus Response Act, the first coronavirus relief bill passed in March 2020, states received a 6.2 percent boost in federal Medicaid funding in exchange for halting disenrollments. 

The usual process of conducting “redeterminations,” in which states redetermine whether a beneficiary’s income levels or other factors still qualify them for Medicaid, has been paused for almost two years. States can still conduct these checks, but they can’t cut off anyone’s Medicaid until the end of the public health emergency (PHE) the federal government declared at the beginning of the COVID-19 pandemic. 

But when the PHE finally expires, states will once again be allowed to remove people from Medicaid rolls. State governments will even be incentivized to do so, because the additional federal money to pay for all those extra enrollees will expire just 60 days after the PHE ends. 

Adding to this pressure is a right-wing campaign pushing to end the PHE and calling on states to start disenrolling people immediately, even before the PHE ends. Republicans in the Senate passed a resolution to end the PHE last week, with Sen. Roger Marshall (R-Kan.) saying the powers it granted the government “are no longer necessary.” 

The PHE is likely to continue until July or later, but could end as soon as April. That means that even though the Centers for Medicare and Medicaid Services (CMS) has given states up to 14 months to resume redeterminations, states are likely already preparing to slash their Medicaid rolls enough to offset the coming loss of federal funding.

The potential scale of this mass disenrollment could be huge: The Urban Institute estimated in September that up to 15 million people could lose their Medicaid coverage when the PHE ends. The Georgetown Center for Children and Families estimated in a report released in February that 6.7 million children are likely to lose coverage. Many of the new enrollees over the past few years will genuinely no longer be eligible — not a surprise, since the income limits for Medicaid are very low — but many others who are eligible will lose coverage anyway.