Millions May Lose Their Pandemic Medicaid Coverage

The expiration of a temporary pandemic measure could cause headaches for states and Medicaid enrollees.

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A notice from the state of Arkansas stating an enrollee is ineligible for Medicaid benefits. (Photo by Brandon Dill for The Washington Post via Getty Images)

Between 5 million and 14 million people could lose Medicaid coverage over the next year as a pandemic-era benefit unwinds, according to a Kaiser Family Foundation projection. That doesn’t mean a crisis is imminent, but how individual states handle the process will play a major role in determining whether it becomes a calamity or a nothingburger.

The “unwinding” begins April 1, after the continuous enrollment requirement state governments signed on to as part of the Families First Coronavirus Response Act (FFCRA) in March 2020 ends.

The “vast majority” of people losing Medicaid coverage will be eligible for other forms of insurance, including subsidized plans under the Affordable Care Act that will still be “highly valuable to them as opposed to being uninsured,” said American Enterprise Institute Senior Fellow Jim Capretta. But it’ll be a daunting administrative task for states.

What is being unwound?

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  1. Avatar photo
    Earl King

    There are interesting incentives in America. I have a friend and relative who work the system of benefits pretty well. They both work at keeping their income low in order to qualify for benefits. Both are able bodied and could work but choose not to. Phil Gramm in a recent book outlined the value of the benefits for those who receive subsidies and or credits if they are below the poverty line. It totaled up to around $54,000. Think of medicaid, food stamps (EBT card), housing subsidies and the like. Conversely the government when calculating the wealth gap never includes the taxes paid...as if anybody’s gross paycheck is something people actually keep. This kind of distortion prevents an honest conversation about poverty and government programs.

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    J. Eric

    Another helpful explainer. Thanks

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  3. Stormer93

    It's unfortunately that Medicaid was the vehicle chosen for increasingly coverage for a couple reasons. First it's funding mechanism causes states to be distrustful of how long the federal government will keep picking up the tab. If the Feds suddenly pull out, then states may have to raise taxes dramatically to make up the difference or just revoke coverage. Second, many providers really hate having to deal with its reimbursement policy- to the point that many simply refuse to accept Medicaid patients. Unless the problems with the program are addressed, it's simply not a good way to address public health issues.

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    Gibby

    Does this mean that some state agencies (mental health facilities) will begin to see a revenue dry up?

    Are there people who need services (due to mental health crises created by the unsound government lockdowns and restrictions) who will suddenly become ineligible?

    In the middle of a mental health crisis (which is happening) this is something that the administration will regret.

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    Matt Hannon

    The governor with the largest buzz-word vocabulary demonstrates conflation of ideas and cognitive dissonance at the same time while “... implementing bold policies that move people from government dependency to a lifetime of prosperity” Grab those boot-straps everyone.

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    1. Avatar photo
      Jeff Younger

      Yes, because work requirements for government assistance are one step removed from chattel slavery, right? The current administration has had its cake and eaten it too - they took credit for ending the pandemic while simultaneously insisting the pandemic was ongoing so they could maintain emergency powers and spending levels. That has not only ballooned the federal debt, it created incentives for people to remain out of the labor force. I’m not claiming these folks are living lives of luxury, but too many able-bodied Americans remain idle during a prolonged shortage of workers.

      Some will decry the unfairness of having to meet work requirements for government aid, but many more will simply get a job, which will either provide insurance or potentially sufficient income to purchase a subsidized ACA plan (not 100%, but we’ll never get there, sorry). Snark all you want about bootstraps, but if more Americans went back to work, a great many of our economic problems would become more manageable. Having served on the board of a large community service organization, I’ve seen firsthand the benefits that accrue to individuals who shift from government assistance to self-sufficiency. It doesn’t mean that everyone can make that shift, or that government and nonprofit programs aren’t necessary, but creating a permanent dependent class is in no one’s best interest, especially the able-bodied poor.

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      1. Mary Stine

        "Creating a permanent dependent class is in no one's best interest, especially the able-bodied poor". Amen to that. I had to sit in a Medicaid office several times with a family member, and wait for two hours just to get in line to wait another two hours. That gave me plenty of time to observe the folks there, many of whom had appeared exhausted and just barely holding on.
        I listened to several people relate in a sad voice that their job had ended, and they needed to be reinstated, because they'd been looking for over a month and were at their wit's end. I gleaned from listening that nearly everyone preferred a job, any job, over being on Medicaid.
        I could only think of my minister friend, who grew up very poor and in adulthood started a ministry to the poor in Kansas City, Kansas. He was deeply aware of how much pride is stripped away from the poor, especially those without work. His ministry carries on today, working to get the working poor support to find and keep a job, navigate the maze of paperwork for legal contracts and utilities and licensing, round up transportation and donated used cars, provide proper attire for job interviews and childcare.
        Here in Kansas there is only patchwork public transportation, walking and biking are only possible for shorter distances, as the whole area is heavily crisscrossed by interstate highways. Low income housing is in extremely short supply, partly due to gentrification, but mostly to the very high cost of either building or maintaining rental property. There are help wanted signs in nearly every business window , but the fact that they stay there tells me few of those jobs are ful ltime that pay insurance. Small manufacturers in our area are begging the community colleges to offer classes in their fields.
        It seems to me many poor people are just utilizing the only system open to them they can depend on. How could we change this?
        1.) ramp up public transportation like buses to have at least one 24 hour run. Offer workers financial incentives or gasoline vouchers for ride sharing.
        2.) create a coalition of small business owners to support scholarships and grants for poor students of promise. Tie these to community colleges and not just a degree path, and offer them in varying amounts based on tuition costs and academic performance. Even $500.00 can go a long way for some trades and computer classes. My son's state college had scholarships like this to support engineering students in the automotive, plastics and building trades.
        3.) start a store for poor people getting back on their feet by training and hiring some of the poor to run the place, others to handle pick up and delivery. This has already happened in a few places and it works when there is oversight to be sure donations are safe and in good order.
        4.) support small grocery stores and child care in poor areas. Areas where these were supported had lowered crime and higher job levels
        5.) help poor communities start community gardens. My church did this and now there are two entrepreneurs in that community hiring workers, providing fresh produce 8 months out of the year and growing hope. And there are now two large community gardens, fertile and free to work for the citizens living there. It's a source of real pride and a place where all ages can work together.
        6.) Churches can help poor communities convert old, barny churches to also function as day care centers for elders, as well as children. Poor communities often lack funds to maintain any building, so support for that helps the community thrive and get back on it's feet. A church that has space for community gatherings, with functioning safe kitchens, bathrooms and central air and heating can be a lifesaver, especially in bad weather. It can also be a classroom where grandmothers and grandfathers can pass on life skills like cooking, sewing and shop work, along with scriptural wisdom. That's what my church did with an old stone building in a rundown area of downtown. It's now humming with important activities all week, including services.
        7.) get college students to canvass the country assessing the actual number of people who are on the autism spectrum or have ADD or ADHD. These are not conditions that should prevent gainful employment for those with milder symptoms, but we as a society need to recognize both what values these brain differences offer, as well as the challenges. It has been long suspected that
        these factors play into job burnout, unemployment and homelessness. It's past time we looked at this objectively and optimistically.

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          Kmregan7

          All of these are great. You know what I don't see in your comment: the lie that people who are "dependent on the government" (and let's be honest, we are ALL dependent on our governments, at all levels, in various ways but no one really wants to admit it) just don't want to work, which is the attitude simply dripping from Jeff's comment.

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          Jeff Younger

          You’re right that it’s an “all hands on deck” effort that’s required to help people transition to productive, independent lives. Often times I’ve encountered people who’ve lived their entire lives dependent on government assistance, and they lack be the most rudimentary skills for entering the work force. Generational poverty deprives these people of the examples most of us take for granted (intact families with one or both parent gainfully employed). Even the most basic skills (timeliness, proper work attire, appropriate professional behavior, etc.) must be taught to many, as they’ve simply never been exposed. It’s hard, often exhausting work, but it can pay off, and when it does, it’s extraordinarily gratifying. The best welfare program in the world is a job, and nothing I’ve seen improves a person’s self-esteem more than entering the working world and becoming self-sufficient. I wish more government programs were geared toward this end.

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        Matt Hannon

        Cognitive dissonance. Thank you

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