Nearly 90% of Medicaid members at risk of losing coverage during a pandemic

Nearly 90% of people expected to receive Medicaid coverage during the COVID-19 pandemic could be dropped from the program after the public health emergency ends, according to a new report.

Federal law prohibits states from excluding beneficiaries from their Medicaid programs during a public health emergency. This, combined with the loss of jobs due to COVID, has left the number of participants higher than usual. However, 15 million new members are at risk of losing insurance coverage after the federal government ends its declaration of emergency, the Urban Development Institute said in a report released Wednesday.

The report notes that more than 9 million adults and non-elderly children were enrolled in Medicaid between February 2020 and January 2021. The researchers estimate that coverage will grow by 17 million by the end of 2021 compared to the pre-pandemic period, bringing the total number of Medicaid participants to 76.3 million.

Of the approximately 15 million people who could lose coverage, 8.7 million are adults and 5.9 million are children. Researchers estimate that one-third of adults who lose coverage would be eligible for subsidized private health insurance in the Affordable Care Act markets, and nearly everyone else would have access to employer insurance in their families.

Of the children who have lost coverage, 57% will be eligible for the Child Health Insurance Program, and another 9% will be eligible for subsidized coverage under the ACA.

State and federal policymakers will need to balance both the need for Medicaid members to secure coverage and the financial pressures facing state and local governments, Matthew Buttgens, senior fellow at the Urban Institute, said in a statement on the findings.

“States can take steps to minimize unnecessary layoffs and ensure that those who lose Medicaid coverage are aware of other coverage options, such as premium tax benefit coverage,” he said.

Last month, the Centers for Medicare and Medicaid said they would grant states a full year after the end of the public health emergency to complete the redefinition of eligibility for Medicaid recipients, up from the previous six months. Stakeholders stated that this change will provide more time and flexibility.

The Urban Institute report notes that CMS can continue to help states by encouraging them to make changes to their programs during a pandemic. For example, some states may extend changes they have made to their disaster relief plans.

The report also called for Congress to maximize the number of people eligible for tax credits under the ACA market plans by making permanent increased tax credits under the American Rescue Plan Act. It also says Congress should extend the increased federal funds to payments that go to states, known as percentage federal health care, throughout 2022 so that they are not pressured to fire people. The extended FMAP expires in March 2022.

Expanding access to Medicaid improves health outcomes, especially among communities of color and low-income people, Avenel Joseph, vice president of policy for the Robert Wood Johnson Foundation, said in a statement. RWJF funded the report.

“Expanding access to affordable and comprehensive health care will bring the country much closer to narrowing long-standing racial and ethnic health disparities that have exacerbated the pandemic,” she said.