{"id":550443,"date":"2022-03-10T15:32:33","date_gmt":"2022-03-10T15:32:33","guid":{"rendered":"https:\/\/jacobinmag.com\/2022\/03\/medicaid-insurance-state-phe-disenrollment-contractors-health-care-eligibility\/"},"modified":"2022-03-10T15:48:26","modified_gmt":"2022-03-10T15:48:26","slug":"a-massive-purge-of-the-medicaid-rolls-is-coming","status":"publish","type":"post","link":"https:\/\/radiofree.asia\/2022\/03\/10\/a-massive-purge-of-the-medicaid-rolls-is-coming\/","title":{"rendered":"A Massive Purge of the Medicaid Rolls Is Coming"},"content":{"rendered":"\n \n\n\n\n

When the pandemic officially ends, millions of Americans will lose federal health coverage. For-profit health industry contractors are poised to massively cash in on their misery and precarity.<\/h3>\n\n\n
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\n A group of activists protest Medicaid cuts in New York City, 2017. (Drew Angerer \/ Getty Images)\n <\/figcaption> \n<\/figure>\n\n\n\n\n \n

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\u00a077.8 million<\/a>.<\/p>\n

This isn\u2019t because of some nationwide change of heart in state governments; it\u2019s 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.<\/p>\n

The usual process of conducting \u201credeterminations,\u201d in which states redetermine whether a beneficiary\u2019s 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\u2019t cut off anyone\u2019s Medicaid until the end of the public health emergency (PHE) the federal government declared at the beginning of the COVID-19 pandemic.<\/p>\n

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 sixty days after the PHE ends.<\/p>\n

Adding to this pressure is a right-wing campaign pushing to\u00a0end the PHE<\/a>\u00a0and calling on states to start disenrolling people immediately, even before the PHE ends. Republicans in the Senate\u00a0passed<\/a> a resolution to end the PHE last week, with Senator Roger Marshall (R-KS) saying the powers it granted the government \u201care no longer necessary.\u201d<\/p>\n

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\u00a0given states up to fourteen months<\/a>\u00a0to resume redeterminations, states are likely already preparing to slash their Medicaid rolls enough to offset the coming loss of federal funding.<\/p>\n

The potential scale of this mass disenrollment could be huge: the Urban Institute estimated<\/a>\u00a0in 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\u00a0report<\/a> 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 \u2014 not a surprise, since the income limits for Medicaid are very low \u2014 but many others who are eligible will lose coverage anyway.<\/p>\n\n \n\n \n \n \n

Bad Incentives<\/h2>\n \n

In the United States, most public programs ostensibly designed to help people are difficult to access. Onerous means-testing requirements, limited availability, or just plain underfunding all limit access to the social safety net. Of every hundred families with children in poverty<\/a>, for example, just twenty-one are on the federal cash welfare program.<\/p>\n

Medicaid is no different. In 2020, a quarter of uninsured people, or roughly 7 million people,\u00a0were eligible<\/a> for Medicaid but remained uninsured. Why would anyone choose to be uninsured in a country where a medical emergency can bankrupt you, if they could get Medicaid? They don\u2019t: they lose insurance when their income increases<\/a>, or due to administrative barriers. Simply missing a piece of mail can lead to losing coverage very quickly.<\/p>\n

Under non-pandemic circumstances, it\u2019s extremely common for eligible people to lose Medicaid because of administrative hurdles. If the state needs more documentation from a beneficiary, the state only needs to provide a minimum of ten days to respond to a letter. If they don\u2019t provide the right document in this short time \u2014 often less than the amount of time it takes for a letter to even arrive \u2014 their Medicaid can be cut off. States can take steps to conduct eligibility checks using their own data, such as quarterly wage reports, but automatic renewals that involve no input from beneficiaries make up a small minority<\/a>\u00a0of all renewals; some states will ask people with no income to\u00a0prove<\/em>\u00a0they have no income.<\/p>\n

Usually, these redeterminations happen on a rolling basis, depending on the date a beneficiary signed up. Now, states are going to have to determine the eligibility of everyone on their rolls at once. (States must conduct redeterminations after the end of the PHE before disenrolling any beneficiaries, according to CMS guidance.)<\/p>\n