Lindsey McNeil and her 7-year-old daughter, Noelle, who has cerebral palsy and epilepsy, were upset when they received a letter from the Florida Department of Children and Families late last month saying Noelle would lose her Medicaid coverage in 10 days.
Since then, McNeil said their lives have begun to unravel. Noel has stopped seeing the four therapists he visits weekly and is running out of the medication he needs to prevent the attacks from recurring. Monday brought some relief. McNeil learned that Noel's insurance coverage had been temporarily reinstated pending resolution of an appeal filed with the state.
“We've worked hard to grow our family and our lives and give this child a home,” McNeil said. “It's a little daunting for her to think about what she stands to lose and what we can't offer her.”
Noel is the latest casualty of the lifting of a pandemic-era federal policy that required states to keep low-income Americans enrolled in Medicaid, the health insurance program, in exchange for increased federal funding. He was one of those who became While this policy was in place, registrants were exempt from periodic eligibility checks. Enrollment in Medicaid and the Children's Health Insurance Program has soared to a record 90 million or more, and the nation's uninsured rate has fallen to record lows.
But that policy expired in early April last year, allowing states to resume roll reductions, and the so-called rollback process that followed had far-reaching implications. More than 20 million Americans lost Medicaid at some point in the past year, the most in the nearly 60-year history of the joint federal-state program, according to KFF, a nonprofit health policy research group. This is an unprecedented event.
The chaos is not over yet. Daniel Tsai, a senior official at the federal Centers for Medicare and Medicaid Services, said the renewal review is only about 70% complete and millions more could lose coverage before the process is completed. Suggests.
Here are some lessons from the past year of Medicaid cuts.
Many people who lose insurance do not find replacement coverage.
A study released Friday by KFF found that nearly a quarter of adults who lost Medicaid during Medicaid release said they were currently uninsured, and 70% of those removed from the program were at least temporarily uninsured. He said he was insured.
The Affordable Care Act's marketplace, which saw record enrollment in 2024, became a refuge for some. Georgetown University researcher Edwin Park pointed to recent federal data showing that roughly 25 percent of people who lose Medicaid enroll in marketplace plans.
Children are especially hard hit.
Before the relaxation began, more than half of the nation's children were covered by Medicaid or the Children's Health Insurance Program, and the burden on the population is significant.
Nearly 5 million children have lost Medicaid to date, according to state data analyzed by Georgetown researchers. About 2 million of them live in Texas, Georgia and Florida, none of which have expanded programs under the Affordable Care Act.
Even a temporary loss of coverage is deeply damaging. In Richmond, Virginia, Trina King's 12-year-old son, Jerome, who has Down syndrome, went without Medicaid for about two months from late summer to early fall last year. King said the gap was the result of several delays in verifying Jerome's eligibility after he moved and did not receive a renewal packet. King said his mail was sent to his old address even though he notified the state he was moving.
When Jerome eventually had his coverage restored, he skipped an appointment with a list of specialists who accept Medicaid, including a spine doctor. Specialist in otorhinolaryngology. Cardiologist. And she's also a urologist, Ms. King said. During her interview period, an appointment with her home health aide had to be canceled. King postponed Jerome's much-needed follow-up appointments for her surgery and missed some of her regular medical appointments.
Most people are dismissed because of bureaucratic mistakes.
Like Jerome, about 70 percent of people who lost Medicaid were terminated for what appeared to be procedural reasons, according to a KFF analysis of state data. Many people lost their insurance because they didn't return the required documents to their state's Medicaid office, while others accidentally activated it due to a technical glitch.
Hunter Jolly, a 33-year-old bartender in Little Rock, Arkansas, makes about $19,000 a year but lost his Medicaid last fall when his renewal paperwork was mailed to his old address. MX Jolly, who uses the pronouns they and they, said that despite applying three times to return to the program, he was unable to secure coverage again.
“It's all very scary,” Mx. Jolie said, adding that they skipped medical and therapy appointments, reduced their psychiatric appointments to once every three months, and paid $270 out of pocket. .
These technical errors are due, in part, to the way Medicaid is organized.
Health policy experts said differences in how states set up their Medicaid programs help explain the disparity in disenrollment rates by procedure.
“When people talk about aggregate numbers, they often think of one big Medicaid program, but the experience of people across the country varies widely depending on the state they live in,” said Tsai, the federal Medicaid official.
Jennifer Tolbert, a health policy expert at KFF, said the relaxations have meant that each state uses different technology, some of which is outdated and defective, and the nation's highly decentralized Medicaid management system. said to have been exposed.
Kelly Cantrell, Nevada's top Medicaid official, said the software the state uses to check eligibility isn't programmed to accurately vet each member of a household, and the problem meant that at one point, even children said that they were excluded from Medicaid. You still qualify. The state contractor responsible for the software has had to scramble to update it, she added.
Conducting enrollment checks has been a complex task even for large state Medicaid authorities. Pennsylvania had about 6,000 full-time employees working on the rollback effort, said Hoa Pham, an official with the state Department of Human Services.
Some argue that cutting enrollment would restore Medicaid to its original scope.
Some health policy experts and state leaders have argued that Medicaid enrollment needs to be cut over the past year to keep the program afloat for eligible people.
Researchers at the Paragon Health Institute, a conservative policy research organization, found last summer that about 18 million people are ineligible for Medicaid, costing the program more than $80 billion a year. It was estimated that
“Medicaid has eligibility requirements,” says Paragon researcher Drew Gonshorowski. He has written a book about the potential savings from cutting Medicaid rolls. “We shouldn't just expand coverage haphazardly without determining eligibility. The program should work as intended.”