Millions to lose coverage during the ‘unwinding’

By Peter White/Ethnic Media Services

Starting in April millions of families could see their health coverage disappear as the government unwinds pandemic-era policies.

During 12 months after April 1, 2023, between 15-18 million Americans will lose health coverage provided during the COVID-19 pandemic by the Families First Coronavirus Response Act.

“Through COVID legislation, states have mostly kept people covered through Medicaid without interruption in exchange for an increase in their Medicaid federal matching funds,” says Farah Erzouki, Senior Policy Analyst, Center on Budget and Policy Priorities (CBPP). She spoke to reporters during an Ethnic Media Services briefing co-sponsored by CBPP last week.

When that program ends, so will the continuous coverage requirement, and all 89 million Medicaid enrollees will have to reapply to renew their eligibility. Erzouki says enrollment in Medicaid grew to 89 million-plus people since February of 2020, an increase of 30%. It was the biggest experiment in universal health care since the 2010 Affordable Care Act (ACA) was passed in 2010.

“Access to coverage and healthcare services has been critical during this time of increased hardship. At the same time, this continuous coverage policy has meant that most Medicaid enrollees probably have not had contact with their Medicaid agencies in three years, and in some cases, even longer,” she said.

Erzouki said that people would have to do the paperwork in order to keep their medical coverage. People have moved during the pandemic or may not receive their renewal notice in the mail.

Erzouki said in the coming months Medicaid agencies are going to be overwhelmed processing cases and documents. She estimated seven million people could lose their coverage due to paperwork issues although they are still eligible.

“They need to make sure that their Medicaid agency has updated contact information for them,” said Laura Guerra-Cardus, CBPP’s Director of State Medicaid Strategy.

Centers for Medicare and Medicaid have dubbed the end of expanded health coverage an “Unwinding.”

The Biden Administration could extend the date of the Public Health Emergency (PHE) for another 90 days and the continuous coverage requirement would remain for another three months. However, at some point it would end.

The Centers for Medicare and Medicaid Services (CMS) projects that some 8.2 million Medicaid recipients who reapply will no longer qualify and will have to transition to another source of coverage. Another 6.8 million will lose Medicaid coverage despite still being eligible.

“Check your mail,” says Guerra-Cardus. People could receive letters at some point from either Medicaid or CHIP and they should complete the renewal forms if they get one, she says. If they don’t qualify, they may be able to get affordable coverage through the Affordable Care Act marketplace and can learn more by visiting www.healthcare.gov

“However, people are given a pretty limited time after they lose Medicaid coverage to transition to the ACA. So the concern there is that people won’t have enough time to enroll in the marketplace after they lose Medicaid coverage without experiencing some sort of gap in coverage,” she said.

Eligibility and income requirements vary widely by state. So contacting non-profit groups can help you fill out state-specific applications forms. For local help filling out an application go to: https://widget.getcoveredamerica.org

Children (5.3 million) and young adults (4.7 million) will lose CHIP/Medicaid coverage. Nearly one-third of those predicted to lose coverage are Latino (4.6 million) and 15% (2.2 million) are Black, according to CMS.

Medi-Cal, California’s Medicaid program, covers 15 million people regardless of immigration status.

“One third of our population use this as insurance for children. Over half of all California children have coverage through Medi-Cal,” says Kristen Testa, Health Director at The Children’s Partnership.

“So this unwinding will have a tremendous effect on all those families. Every one of them is going to have to renew,” she said.

Calling this period “an all hands on deck situation,” Testa noted there are community-based organizations all over California that are trained and given grants to help with enrollment.

“There’s also the California Health Department website that has listings across the state,” she said.

California passed a continuous coverage law last year for young children that won’t go into effect until 2025, so some kids are going to lose coverage in the interim.

“So the important thing is for everybody to know and help our community renew their coverage and know where to go,” she said.

Not so lucky are people in 11 states that did not expand Medicaid under the ACA or the American Rescue Plan.

CMS estimated 383,000 individuals, who will lose eligibility for Medicaid, would fall in the coverage gap in the remaining 11 non-expansion states – with incomes too high for Medicaid, but too low to receive Marketplace tax credits.

CMS noted that state adoption of Medicaid expansion in these states would mitigate potential coverage loss at the end of the Public Health Emergency (PHE). Those states are Wyoming, Wisconsin, Kansas, Texas, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and Florida.

“This is a moment where we’re going to really feel the stark differences across our country. In the eleven remaining non-expansion states, eight of which are in the south, there is already too little access to healthcare coverage for people, including communities of color,” Guerra-Cardus said.

After being able to take care of their healthcare needs for several years, she said that some people suddenly will lose coverage and not have any other option for affordable coverage.