Around 30 million of the poorest Americans may be removed from the Medicaid program, due to flawed state reviews that poverty experts argue the Biden administration is not doing enough to address. Avalere, a health consulting firm, has projected these numbers as states conduct a comprehensive reassessment of the 94 million people enrolled in Medicaid, the government’s health insurance for low-income individuals. Various issues have emerged across the country, such as long phone wait times in Florida, confusing government forms in Arkansas, and incorrect removal of children from coverage in Texas.
Trevor Hawkins, an attorney for Legal Aid of Arkansas, stated that the individuals affected were set up to fail. Hawkins assisted hundreds of people in navigating their Medicaid eligibility in Arkansas, as state officials swiftly removed around 420,000 people from the program in just six months. He raised concerns about the Arkansas process, including forms that incorrectly instructed people to reapply for Medicaid instead of renewing it, with the Centers for Medicare and Medicaid Services (CMS). However, no changes were made.
Advocates from across the country have reported widespread problems while assisting an estimated 10 million people who have already been dropped from Medicaid. Some fear that systemic issues are being overlooked. Last year, Congress ended a COVID-19 policy that prevented states from removing anyone from Medicaid during the pandemic, requiring them to review the eligibility of every enrollee over the next year. However, Congress also granted Health and Human Services Secretary Xavier Becerra the authority to fine states or halt disenrollments if individuals were being improperly removed.
HHS has provided limited information about the issues it has uncovered. Earlier this year, the agency temporarily halted disenrollments in 14 states, but did not disclose the specific states or reasons for the pause. In August, HHS announced that thousands of children had been wrongly removed in 29 states that were erroneously removing entire households instead of individuals from coverage. CMS mandated that the states reinstate coverage for those terminated under this process.
Lily Mezquita, a 31-year-old working mother in Miami, Florida, faced two attempts to remove her from Medicaid during her pregnancy this year. She made 17 phone calls, with wait times of up to two hours, before being reinstated in August from her hospital bed while experiencing preterm labor. Mezquita had to pay out-of-pocket for prescribed medication and missed follow-up appointments for her baby due to delays in her coverage registering in the state’s system.
According to Avalere’s projections, if current trends continue, up to 30 million people could ultimately lose Medicaid coverage once states complete their eligibility reviews. This number far exceeds the Biden administration’s initial estimate of 15 million individuals losing coverage throughout the process. Most removals have occurred due to procedural reasons, such as failure to return renewal forms or submit required paperwork. This indicates larger problems with how states are determining Medicaid eligibility, including issues with delivering notices, confusing instructions, and unnecessary paperwork. Many of those removed may still qualify for Medicaid.
In Arkansas, which has completed its Medicaid redeterminations, public records obtained by the AP show that over 70% of people were removed because the state couldn’t reach them or they failed to return renewal forms or provide requested documentation. Similar problems, such as long wait times and vague removal notices, have plagued the process in Florida. Medicaid enrollees in North Carolina have also encountered difficulties reaching local offices by phone or receiving callbacks. Texas has experienced website and app outages, resulting in families being unaware of their denied Medicaid coverage until visiting healthcare providers. CMS has met with various organizations to address these issues, but in some cases, the problems raised do not violate federal regulations.
CMS has historically attempted to work cooperatively with states on Medicaid, hoping to improve the enrollment process for years to come. Local groups have been reporting problems to national organizations that meet with CMS on a weekly basis. However, there are questions about whether it is time to shift towards enforcement in certain states.
