As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage

Lambert here: Wait ’til the AI claims reviewers kick in. If they haven’t already. Last week, private health insurance. This week, Medicaid. Apparently, the ruling class decided that too many of us are insured. Note the role of complex eligibility requirements — and the PMC gatekeepers who enforce them — in selecting those who go to Happyville, and those who go to Pain City.

By Hannah Recht, Data Reporter, who covers health care by assembling databases, digging through documents, analyzing data, and talking to people, too. Originally published at KFF News.

More than 600,000 Americans have lost Medicaid coverage since pandemic protections ended on April 1. And a KFF Health News analysis of state data shows the vast majority were removed from state rolls for not completing paperwork.

Under normal circumstances, states review their Medicaid enrollment lists regularly to ensure every recipient qualifies for coverage. But because of a nationwide pause in those reviews during the pandemic, the health insurance program for low-income and disabled Americans kept people covered even if they no longer qualified.

Now, in what’s known as the Medicaid unwinding, states are combing through rolls and deciding who stays and who goes. People who are no longer eligible or don’t complete paperwork in time will be dropped.

The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.

KFF Health News sought data from the 19 states that started cancellations by May 1. Based on records from 14 states that provided detailed numbers, either in response to a public records request or by posting online, 36% of people whose eligibility was reviewed have been disenrolled.

In Indiana, 53,000 residents lost coverage in the first month of the unwinding, 89% for procedural reasons like not returning renewal forms. State Rep. Ed Clere, a Republican, expressed dismay at those “staggering numbers” in a May 24 Medicaid advisory group meeting, repeatedly questioning state officials about forms mailed to out-of-date addresses and urging them to give people more than two weeks’ notice before canceling their coverage.

Clere warned that the cancellations set in motion an avoidable revolving door. Some people dropped from Medicaid will have to forgo filling prescriptions and cancel doctor visits because they can’t afford care. Months down the line, after untreated chronic illnesses spiral out of control, they’ll end up in the emergency room where social workers will need to again help them join the program, he said.

Before the unwinding, more than 1 in 4 Americans — 93 million — were covered by Medicaid or CHIP, the Children’s Health Insurance Program, according to KFF Health News’ analysis of the latest enrollment data. Half of all kids are covered by the programs.

About 15 million people will be dropped over the next year as states review participants’ eligibility in monthly tranches.

Most people will find health coverage through new jobs or qualify for subsidized plans through the Affordable Care Act. But millions of others, including many children, will become uninsured and unable to afford basic prescriptions or preventive care. The uninsured rate among those under 65 is projected to rise from a historical low of 8.3% today to 9.3% next year, according to the Congressional Budget Office.

Because each state is handling the unwinding differently, the share of enrollees dropped in the first weeks varies widely.

Several states are first reviewing people officials believe are no longer eligible or who haven’t recently used their insurance. High cancellation rates in those states should level out as the agencies move on to people who likely still qualify.

In Utah, nearly 56% of people included in early reviews were dropped. In New Hampshire, 44% received cancellation letters within the first two months — almost all for procedural reasons, like not returning paperwork.

But New Hampshire officials found that thousands of people who didn’t fill out the forms indeed earn too much to qualify, according to Henry Lipman, the state’s Medicaid director. They would have been denied anyway. Even so, more people than he expected are not returning renewal forms. “That tells us that we need to change up our strategy,” said Lipman.

In other states, like Virginia and Nebraska, which aren’t prioritizing renewals by likely eligibility, about 90% have been renewed.

Because of the three-year pause in renewals, many people on Medicaid have never been through the process or aren’t aware they may need to fill out long verification forms, as a recent KFF poll found. Some people moved and didn’t update their contact information.

And while agencies are required to assist enrollees who don’t speak English well, many are sending the forms in only a few common languages.

Tens of thousands of children are losing coverage, as researchers have warned, even though some may still qualify for Medicaid or CHIP. In its first month of reviews, South Dakota ended coverage for 10% of all Medicaid and CHIP enrollees in the state. More than half of them were children. In Arkansas, about 40% were kids.

Many parents don’t know that limits on household income are significantly higher for children than adults. Parents should fill out renewal forms even if they don’t qualify themselves, said Joan Alker, executive director of the Georgetown University Center for Children and Families.

New Hampshire has moved most families with children to the end of the review process. Lipman, the state’s Medicaid director, said his biggest worry is that a child will end up uninsured. Florida also planned to push kids with serious health conditions and other vulnerable groups to the end of the review line.

But according to Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project, state officials sent cancellation letters to several clients with disabled children who probably still qualify. She’s helping those families appeal.

Nearly 250,000 Floridians reviewed in the first month of the unwinding lost coverage, 82% of them for reasons like incomplete paperwork, the state reported to federal authorities. House Democrats from the state petitioned Republican Gov. Ron DeSantis to pause the unwinding.

Advocacy coalitions in both Florida and Arkansas also have called for investigations into the review process and a pause on cancellations.

The state is contacting enrollees by phone, email, and text, and continues to process late applications, said Tori Cuddy, a spokesperson for the Florida Department of Children and Families. Cuddy did not respond to questions about issues raised in the petitions.

Federal officials are investigating those complaints and any other problems that emerge, said Dan Tsai, director of the Center for Medicaid & CHIP Services. “If we find that the rules are not being followed, we will take action.”

His agency has directed states to automatically reenroll residents using data from other government programs like unemployment and food assistance when possible. Anyone who can’t be approved through that process must act quickly.

“For the past three years, people have been told to ignore the mail around this, that the renewal was not going to lead to a termination.” Suddenly that mail matters, he said.

Federal law requires states to tell people why they’re losing Medicaid coverage and how to appeal the decision.

Harmatz said some cancellation notices in Florida are vague and could violate due process rules. Letters that she’s seen say “your Medicaid for this period is ending” rather than providing a specific reason for disenrollment, like having too high an income or incomplete paperwork.

If a person requests a hearing before their cancellation takes effect, they can stay covered during the appeals process. Even after being disenrolled, many still have a 90-day window to restore coverage.

In New Hampshire, 13% of people deemed ineligible in the first month have asked for extra time to provide the necessary records. “If you’re eligible for Medicaid, we don’t want you to lose it,” said Lipman.

Clere, the Indiana state representative, pushed his state’s Medicaid officials during the May meeting to immediately make changes to avoid people unnecessarily becoming uninsured. One official responded that they’ll learn and improve over time.

“I’m just concerned that we’re going to be ‘learning’ as a result of people losing coverage,” Clere replied. “So I don’t want to learn at their expense.”

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Michael Fiorillo

    People lost eligibility on the day Trump was indicted for payments to a porn actress, with not a mention by #McResistance media… and no mention that Uncle Joe could have extended it, but didn’t want to (as with increasing the minimum wage, giving railroad workers days off, eliminating student debt, etc.) And of course, when the Ds get clobbered next year, they’ll blame the voters.

    1. Rolf

      Yup. I wonder on what platform, exactly, do Biden and his Democratic Party backers plan to run in 2024? How will he differentiate himself from Trump, or any challenger for that matter?
      — He has championed war, regime change, confrontation with Russia and China, giving lie to promises of “relentless diplomacy” in foreign affairs;
      — He has as much admitted his role in terroristic destruction of critical infrastructure — NS2;
      — He wastes billions in a proxy war that serves only to illuminate how little the US receives in exchange for its bottomless spending on “defense”;
      — He has reneged on promises that no American personnel would be deployed in Ukraine;
      — He has poisoned relations with nations with whom we shall require deep collaboration to make any headway on global environmental issues;
      — He has refused to remove incompetents from key cabinet and agency appointments;
      — He effectively sabotaged any re-entry into the JCPOA;
      — He has abandoned labor. Allow RR labor to regain some actual leverage? Ah, no.
      — Make a surprise visit to Kiev? No problem! But visit the hapless citizens of East Palestine? Nah … let’em chat with Mayo Pete.

      With every new debacle, he’s made it very clear he has absolutely no intention of acting in the interests of average Americans. “Nothing would fundamentally change?” Bullsh*t. Everything will get fundamentally worse.

      1. Jeremy Grimm

        “He has as much admitted his role in terroristic destruction of critical infrastructure — NS2;”

        What is NS2?

    2. Joe Well

      Agree that we are now objectively no better off under Biden, and in many ways worse. A Biden-Trump election will see historic levels of people sitting out the vote, or possibly provide an opening for any third party candidate with any level of organization whatsoever.

      1. Joe Well

        My God, when I think of how big a disaster it was when Bernie lost the primary. More consequential than Bush’s 2000 theft of the election.

    3. Jeff Jenkins

      Before we get teary eyed, this is a program the vast majority of heritage americans who pay any tax, will never be allowed to access. In the most generous state, NY, one cannot have 1500 dollars in the bank and must have a car worth under 5000–even then there are work critieria. In the South, it’s even worse, you have to be completely broke and rift of property, as well as work at least half-time. And single men still are ineligible.

      So who is using this program, basically immigrants, illegal and otherwise, gaming the system, whether at the micro level–e.g., mulitple islamic wives counted as sisters, or at the macro level, vast billion dollar fraud schemes of immigrant doctors in collusion with their coethnic ghettos.

      I’m not even factoring in how this brings illegal immigrants in. Let’s be real here, the blue collar jobs are closed to americans and pay half of what they did pre-open borders (In 1988, a construction worker earned 18 dollars and hour, now 8 dollars, not adj. for inflation.)

      If a social program is litterally a way to demographically replace the native populaiton and subsidize near slave labor in our midst, what is the point of the program?

  2. PhillipSterling

    Have to make room for the many millions of BiDenvenidos crossing the border. Just cross off the old entitled Americans to make room for new cheap labor, markets and voters.

    March 1, 2022 -“allowing people to sign up for comprehensive Medi-Cal coverage regardless of their immigration status is the single biggest step California can take to insure as many people as possible in the current system. Newsom called his latest planned expansion “universal access to coverage.”

    1. Tommy S

      Allowing the approximate 286,000 ‘illegals’ on Medi-Cal, in no way kicks off natives from getting it. It’s also NOT easy to get anyway. I really see no problem in giving illegals some health care. They are working here, paying taxes, and often paying millions in SS, that they will never get back. Doing this also makes our working class areas here safer, and more healthy for all. And some may be able to find studies that show it actually ‘saves’ money, with preventative care etc.

      1. JBird4049

        They should not be here, but yes, giving any person healthcare is not an evil in my book. It is just giving care to some, while people who were born here are being told no, that is a big, big issue with me.

        1. clyde

          You have to choose your parents carefully in this country if you want to see a doctor.

      2. Whiteylockmandoubled

        More importantly, that undocumented immigrants are now allowed to get MediCal doesn’t mean that they’re on MediCal. Being categorically eligible means you have the same right to the same nightmarish bureaucratic processes as everyone else.

    2. JonnyJames

      Don’t be so naive: Newsom doesn’t give a toss about immigrants – they have no power. This is to subsidize quasi slave labor: the California and US economy has always been dependent on exploited cheap labor.

      Why focus on the powerless, look behind the curtain where the BigMoney is!

      Newsom reportedly has wineries that employ such labor, so he will benefit as well.

    3. Mildred Montana

      Time for my snarky comment of the day.

      I have heard in passing that government deficits and debts don’t matter. So what’s the problem with immigration? Just give the immigrants (illegal or otherwise) whatever they need: Healthcare, housing, food stamps, clothing vouchers, etc. Roll out the golden welcome-mat for them (as many as the Latin and South American countries can send) because those deficits and debts do not matter a whit. Welcome to America! With unlimited credit (or money printing) they will be well provided for, and even Americans will not be displaced by this policy or even inconvenienced because after all there’s money for everyone.

      All areas of fiscal policy could be solved if only stupid governments realized that their deficits and debts were meaningless, a belief in their importance a figment of outdated economic thinking. If only they woke up to the new economic reality, that there will be money without limit for the MIC, Medicare and Medicaid recipients, Social Security, the EPA, SEC, the TSA, the IRS, and yes, all those immigrants lined up at the border.

      How can they be so blind? And what are we arguing about? We’re in a new era where fiscal prudence is unnecessary. The correct policy is to spend, spend, spend; borrow, borrow, borrow.*

      *In case anybody didn’t know, major sarcasm.

  3. Susan the other

    This is a clear criticism of the hypocrisy it takes to triumphantly tout “productivity” while simultaneously squandering time, money, trust, precious health and the last shreds of good will. Instead of all this disgraceful behavior, we could have a well functioning national health insurance system. The transition would be easy with all existing infrastructure already in place. Just change one click from private to public. This whole mess is a dereliction of duty – it’s a shame civic law does not address it.

    1. jobs

      Not “health insurance”, we want “health care”. Making health care for profit impossible would be the sensible, humane and cost-saving thing to do.

  4. Boomheist

    There is an interesting and sad subtext to this: the main problem many people have with navigating the Medicare system is that there is a lot of stuff to understand, wade through, and follow. A lot. I trained to become a SHIP or SHIBA advisor, a volunteer who advises people with Medicare questions, last year, and I can’t tell you the number of people who come in baffled and feeling stupid because despite their education, often gradate degrees, they struggle to make sense of everything. Add to this an assumption by the overall system that everyone is now computer-literate, that everyone should be able to figure everything out by clicking through web pages, and lastly that these days in order to speak to an actual human being you have to first wade through long minutes of phone tree options; that is if you have the patience for it. Remember the good old days when you’d call and get a damn phone tree and just punch “O” to get someone? Long gone.
    Now, add AI to this, namely, AI use to sift through all these rules and forms and logical trees, and set up the AI to do the rote figuring out so real people don’t have to do that. I am guessing that in a large percentage of issues this will work just fine – as an example, to take the case here of Medicaid being lost because of the lifting of the Covid pause, AI can probably determine easily if you are or are not making enough money to fall into the Medicaid-eligible category. The point here though is that the recipient of Medicaid is most likely someone who is on hard times, under stress, probably not healthy, not that computer-literate, and struggling to access other social services as well, a huge demanding job requiring attention to detail and enormous persistence, both hard to have when worried about a roof over your head. The bureaucratic system – insurance companies, maybe now parts of Mericare as well as state Medicaid agencies – however has the budget to install AI and thus save their workers from the stress of managing all this stuff – let AI do it and dip in only when needed. This further places the service agent even more distant from understanding and being sensitive to the needs of the client. So now, along with the assumptions carried by many that a) everyone is computer literate; b) you can always suffer the phone tree to get further information; and c) just more careful reading will solve your issue; we have the additional layer of AI – a system that makes complex decision trees simple and accessible to bureaucrats and even more mystifying to customers. Add to this the constant barrage of mailings from insurance companies promoting their medical system, especially acute during the medicare Open Enrollment period October 15-December 7, and it is no wonder all those millions of people who had Medicaid carried during Covid either never saw or forgot they might have to reapply to maintain their benefits.
    Of course some will argue that this Covid thing has been taken advantage of by some, or many. Let’s say someone who was on Medicaid and then married a wife who was working during the Covid time and hence raised their income above Medicaid limits. Now he loses his Medicaid. This after three years of receiving the support and building a life around that support. It will be a shock. The tragedy here, at least in my experience, is that in addition to all those people who might now lose Medicaid for good or bad reasons, there are countless millions more in what I call the medical Precariat – they make too much to get Medicaid coverage but too little to make a decent life. Many of the people now being pushed off Medicaid are losing it because they need to wrestle with the AI-bureaucratic monster to refile for benefits, something state agencies will do and are happy to do, but which can be scary and intimidating. Some others have been working the system and should not have been on Medicaid to begin with. But, and this is the key “but”, to qualify for Medicaid you need to be very Low Income, as in, in my state, as a single person about a thousand dollars income a month and as a couple call it about 1500 a month. Who can live on that? So let’s say you are a couple with a kid and together you make 3000 a month, gross. This income level means you cannot qualify for Medicaid or anything else, yet from this amount you are expected to pay rent, utilities, food, clothing, child costs, medical insurance, a car, etc etc. There are millions of us in this country, barely hanging on, but hanging on, making enough to barely survive and too much for any aid, but never enough to really build anything.
    I haven’t seen any articles about this, but in my area out in the Pacific Northwest an interesting thing has started happening – it turns out that as doctor practices have been consolidated and bought out into these big networks of services a little research will show that they are owned by… conglomerates. That tells you all you need to know.

    1. Rolf

      … we have the additional layer of AI – a system that makes complex decision trees simple and accessible to bureaucrats and even more mystifying to customers. Add to this the constant barrage of mailings from insurance companies promoting their medical system, especially acute during the medicare Open Enrollment period October 15-December 7, and it is no wonder all those millions of people who had Medicaid carried during Covid either never saw or forgot they might have to reapply to maintain their benefits.

      Great points, Boomheist, thank you for this detailed comment.

      1. Arizona Slim

        Tell me about it!

        Shortly after I turned 64, I started getting pummeled with Medicare Advantage mailings. And let me tell you, those companies put some serious money into the creation of their marketing materials. For some strange reason, they tend to omit the part about these so-called Advantage plans being HMOs that can deny you of care, just like HMOs have always done.

        Meanwhile, I kept waiting for that big Medicare and You book, the same one that my mother got every year. Thing never came.

        Well, the fall of 2022 rolled around, I’m about to turn 65, and I realize that I’d better get cracking on signing up for traditional, classic rock Medicare. Easier said than done.

        I tried enrolling via the website, and I kept getting to the same part of the signup process, but I couldn’t get any further. Website error of some sort.

        So, overt to my phone I went. I called Medicare and waited on hold for about an hour before I was told that I’d need a telephone appointment with the local office here in Tucson. Couldn’t I just go over there and register in person? I mean, the place isn’t that far away from the Arizona Slim Ranch.

        Nope. Gotta be by phone.

        Well, I got a letter and an email stating when my telephone appointment would happen. Someone would call me at my number…

        …and no one ever did.

        I called the number on the letter, got the local office on the line, and I was told that I should come in and register in person.

        Huh? I was recently told that telephone appointments were the only way to go.

        So, on my 65th birthday, I hopped on my bicycle and pedaled over to the Medicare office. Where I was sent to three different windows before I was finally matched with someone who could actually handle my signup process.

        Got the Medicare card, and I also have the supplemental and drug plan cards. Not that I take any drugs, I just have to have that Plan D or pay a penalty for the rest of my life. Funny how that drug cartel works, isn’t it?

        It didn’t have to be this way. Should have been as easy as, well, shopping online. Or, well, posting to Naked Capitalism.

        And, as for that Medicare and You book, I finally got one, several months after I turned 65.

      2. Whiteylockmandoubled

        It’s awful. But you do it once.

        With Medicaid you constantly have to prove you’re poor enough to get health care. Generally you have to prostrate yourself once a year at least, and In most states, if your job changes and you get a decent raise, you have to report it to the state and if it pushes you above eligibility levels you lose coverage at the end of the month.

        What’s happening now is terrible, but it’s also just three years of normal, every day life in a shitty, degrading means-tested health care system compressed into one moment.

    2. JBird4049

      Let’s add the slowly collapsing USPS, which been slowing the mail. Next, the many people who live on a couch or in their car. Even with a mailing address, some people are rental vagabonds moving from address to address.

  5. Hayek's Heelbiter

    /Snark Not a bug but a feature.
    If you can’t jump through all the hoops filling out forms that might have well as been written in Rongo Rongo (still undeciphered despite the best efforts of many brilliant linguists), then you don’t belong in the gene pool in the first place and you SHOULD die quickly.
    This sh*t test will guarantee that you won’t have offspring to contaminate PMC offspring.
    Unless, of course, you happen to a member of the immigrant slave caste, then all is irrelevant /EndSnark

  6. Ana in Sacramento

    Picking Medicare Advantage was not a choice for me. I have exotic genetics and need better than average medical care. The only way I could keep the local University of California Davis teaching hospital after reaching 65 was to “choose” Advantage.

    So with constant flailing at United Health I can continue to get the meds and gear I have to have. I don’t always succeed.

    One of their tricks is to say both yes and no when asked for an authorization for gear. But really it’s “no” which you finally discover is the real answer after the time to file an appeal has passed.

    Another is to turf you out of the hospital or rehab (nursing home) before you can function. Honest to dog, I’ve done the turfed out, transported home, call 911, transported back, get parked again in ER for some days (yes, days) then turfed out to home or nursing home. Rinse repeat.

    Filing and winning an appeal on being turfed out takes months. And has to be done while one is being churned in the rinse repeat cycle.

    I don’t envy anyone who is approaching 65 and has to make a choice between awful or dreadful medical care.

    Ana in Sacramento

  7. Ana in Sacramento

    To clarify, I know the difference between Medicare, Medi-Cal and Medicare Advantage. I believe the outcome is pretty much the same for each system if anything complex (or even simple) is needed. The universal business model is highly complex gatekeeping then “go die”.

    Ana in Sacramento

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