Five states (AR, AZ, ID, NH, SD) started disenrolling people from Medicaid last weekend (April 1st) as the unprecedented Medicaid “unwinding” begins. As readers of SayAhh! know, in exchange for extra federal funds, states have been prohibited from disenrolling anyone involuntarily from Medicaid since March 2020 due to the COVID-19 public health emergency.
Quicker than I expected, we got some information from two states about what happened over the weekend – Idaho and Arizona. Bottom line, just over 19,000 lost their Medicaid coverage in Idaho and Arizona’s monthly Medicaid enrollment dropped by a net decline of approximately 35,000 from March to April.
Different information was publicly shared by these two states and I will unpack what we know.
Idaho’s Department of Health and Welfare Director released a statement on March 31st announcing that approximately 33,000 people who have been in the “Medicaid protection” category (i.e. those who the state had identified as being potentially no longer eligible) had their eligibility processed during February and March and 19,251 have been determined to be ineligible and disenrolled. Idaho’s renewal plan has identified 150,000 people that it believes were protected during the PHE period but are no longer eligible – and is processing renewals for these folks over a six month period which started in February.
Idaho’s statement notes that 8,585 of those who lost Medicaid were enrolled in expansion coverage – so we know these are adults. My guess is that the remaining 10,666 that lost Medicaid are largely children and parents including people covered in the “pregnant women” category whose 60 day postpartum period has expired (Idaho failed to adopt the 12 month postpartum extension this session despite a good deal of support for it), or possibly other parents and family members receiving Transitional Medical Assistance for 12 months when increased earnings would otherwise disqualify them for Medicaid (this turns out to be the largest group losing Medicaid in Arizona as described below). And maybe some adults who aged out of their coverage – like folks who turned 65 and moved to Medicare or children who aged out of Medicaid and whose income was over the CHIP income limit of 190 percent of the federal poverty level.
Another interesting aspect of Idaho’s data is that the state determined that 13,647 of those processed remained eligible – at first blush this seems like a very high percent (41%) of those that the state had on its list to be removed which would be troubling indeed. But the statement notes that beneficiaries have contacted the department proactively to check on their coverage status because they had a “change in circumstances” or “another benefit (such as food stamps)” which prompted their renewal to be completed early. Idaho notes that it will begin publishing more data on April 10th.
Here is what we don’t know about Idaho nor any other state for that matter – how many of these folks will successfully make it to other coverage sources? Idaho runs its own marketplace, Your Health Idaho, but those who lose their Medicaid coverage have just 60 days to enroll. The state notes that those losing Medicaid have been referred there but we don’t know much else. To avoid coverage losses, the state could extend this special enrollment period as the federal government has done for its marketplace. And with many children losing coverage the state doesn’t mention what is happening to transfer any children smoothly to the state’s CHIP program.
Arizona released a spreadsheet of data with eligibility categories and how they changed from March to April. Overall, there was a net loss of 35,107 people from March to April – 1% of program enrollment. The biggest groups by category were families (probably mostly parents) in Transitional Medical Assistance (15,220), 10,138 expansion adults, and 5,838 children. As expected, the vast majority of Medicaid disenrollment is in the income related groups – children, parents (including new ones postpartum) and other adults in expansion states.
Though Arizona indicated in its renewal report that it is prioritizing individuals who were determined potentially ineligible, it specified that renewals for these individuals would be distributed throughout the 12 month unwinding period (from oldest to newest) to ensure that no more than 1/9 of the state’s total caseload would be renewed in a given month. The state also noted plans to align household renewal dates and dates with SNAP recertification. As a result, we don’t know exactly who these folks were.
Hopefully some of those losing Medicaid in both states now have employer-sponsored insurance – though I worry this is less likely for children and spouses since dependent coverage is so expensive. We simply won’t know for a while how many people have become uninsured.
Checking eligibility for approximately 90 million people, including more than half of children in the United States, is a hugely consequential and unprecedented undertaking at a time when states are understaffed. Federal CMS and state agencies have been doing much to prepare for this effort; it will take a village to avoid the worst outcomes.
You can see when your state is starting the disenrollment process here.