Estimated 17 million to lose Medicaid coverage. Here’s where

At least 17 million people across the country will lose Medicaid coverage beginning next month, according to estimates by state government agencies, an unintended consequence of the unwinding of federal regulations that were meant to ensure health care coverage for as many people as possible during the Covid pandemic.

Experts are calling it the biggest shock to the nation’s public health care system since the Affordable Care Act went into effect 13 years ago. But the impact of the end of the emergency varies widely by state.

The so-called continuous enrollment period – three years in which states were prohibited from dropping anyone from their Medicaid rolls – saw an across-the-board increase in the number of people enrolled in the public health insurance program for low income people.

Health policy experts have used those coverage gains as a rough indicator of the number of people who could be dropped now that the requirement is ending on April 1.

A Kaiser Family Foundation analysis predicts that as many as 14.2 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision. The federal Department of Health and Human Services suggests that as many as 15 million people will be unenrolled.

But state-by-state estimates compiled and reviewed by Pluribus News suggest the number of those dropped from Medicaid will be at least 17 million, according to high-end predictions from those state-level agencies – and that estimate does not count those in 11 states where reliable figures have not yet been reported.

The coverage losses will include those who are no longer eligible because of income gains or changes in life status, like having a baby. Untold millions who are still eligible but don’t reenroll could also be lost in the shuffle.

Here are the reported estimates of those who will lose coverage, beginning when states start to unenroll people next month:

Those numbers also don’t tell the whole story. Some states, mostly those with larger populations, have added more people to their Medicaid rolls during the continuous enrollment period, so more people are at risk of losing coverage. Conversely, states that had not expanded Medicaid added fewer people to their roles because of more stringent eligibility guidelines.

Moving forward, some states – mostly blue states seeking to continue the historic gains in insurance coverage during the pandemic – plan to take robust measures to try to keep people from losing their coverage. Officials in those states have cautioned that many of the people who will be dropped from Medicaid will qualify for other programs.

In Oregon, officials have set up a program to allow children to stay on Medicaid until age 6, and to allow everyone else up to two years of eligibility regardless of changes in income without having to reapply. Washington, California and New Mexico have since sought to implement similar programs.

Oregon is also creating a permanent subsidized health plan for people who no longer qualify for Medicaid but have an annual income below 200% of the federal poverty level, which amounts to about $29,000 for an individual.

Rhode Island will automatically move people who no longer qualify for Medicaid but have annual incomes below 200% of the poverty line into an Affordable Care Act plan and pay their first two months of premiums.

Other states that have provided subsidies to individuals purchasing marketplace plans include Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, Vermont and Washington, according to the National Conference of State Legislators.

Some states worried about the expense of a swollen Medicaid program, meanwhile, have sought to speed up the unenrollment period, a strategy that experts say is likely to increase the number of eligible people who will be dropped.

Arkansas plans to complete the process in six months, while Missouri, Montana, South Dakota, Oklahoma and New Hampshire officials told KFF in a March survey that they would finish in 9 to 12 months. Every other state – with the exception of Texas and Indiana, which did not respond to the survey – said they would take 12 to 14 months.

Coverage losses will also be impacted by how aggressively states attempt to reach out to enrollees to inform them that they need to re-enroll to maintain their coverage.

Texas plans to hire 600 additional employees to process Medicaid redeterminations starting in April, and people who lose coverage will automatically have applications for the federal Exchange submitted.  Oklahoma plans to send up to three notices to enrollees across multiple communication channels, according to NCSL.

State data sources: Alabama: Robert Wood Johnson Foundation and the Urban Institute. Arizona: Arizona Health Care Cost Containment System. California: Department of Health Care Services, via State of Reform. Colorado: Reporting from the Colorado Sun. Connecticut: Reporting from Inside Investigator. Delaware: Delaware Health and Social Services. Florida: Reporting from Florida Politics. Georgia: Reporting from Georgia Recorder. Idaho: Idaho Department of Health and Welfare. Illinois: Chicago Tribune. Indiana: WFYI, citing Nonis Spinner, director of eligibility and membership at the Indiana Office of Medicaid Planning and Policy. Kentucky: Reporting from Kentucky Health News. Louisiana: KSLA, citing Louisiana Medicaid Program executive director Tara LeBlanc. Maine: Maine Public Radio, citing the state Department of Health and Human Services. Maryland: Associated Press, citing Maryland Health Benefit Exchange executive director Michele Eberle. Massachusetts: Boston Globe reporting.

Michigan: Bridge MI, citing House Fiscal Agency projections. Minnesota: Minneapolis Star Tribune reporting. Missouri: KCUR reporting. Montana: Milken Institute of Public Health at The George Washington University. Nebraska: State Department of Health and Human Services report. Nevada: State Department of Health and Human Services report. New Hampshire: New Hampshire Bulletin reporting on Medicaid director Henry Lipman. New Jersey: The Urban Institute. New Mexico: Santa Fe New Mexican reporting. New York: Empire Center. North Carolina: WFAE. Ohio: Columbus Dispatch reporting. Oklahoma: The Journal Record. Oregon: KGW reporting on the Oregon Health Authority. Pennsylvania: WHYY.

Rhode Island: WPRI. South Carolina: Live 5 News. Tennessee: Associated Press. Texas: State of Reform. Utah: Utah Health Policy Project, reported by ABC 4. Virginia: Department of Medical Assistance Services. West Virginia: Coal Valley News. Wisconsin: Robert Wood Johnson Foundation and the Urban Institute. Wyoming: Casper Star Tribune reporting on the state Department of Health.