How Medicaid unwinding has affected community health centers

Community health centers—nonprofit facilities located in medically underserved areas that treat roughly 31.5 million people in the US—have been hit hard by the yearlong Medicaid unwinding process, which critics have called chaotic and say has led to disenrollment for roughly 20 million people, according to data from health policy research firm KFF.

Data from trade group the National Association of Community Health Centers (NACHC) showed that disenrollment has cost community health centers an average of $600,000 each. The health centers already operate on tight margins and rely on Medicaid and federal funding to provide access to care for vulnerable communities, including people experiencing homelessness and those in poverty, according to nonprofit health policy research firm the Commonwealth Fund.

“Medicaid is the lifeblood of community health centers and their ability to serve high-need urban, rural, frontier, and island communities,” Kyu Rhee, president and CEO of NACHC, said in a statement. “Both coverage and access to affordable primary care services are essential to achieving health equity, improving population health, and lowering healthcare costs.”

By the numbers:

• An estimated 23% of community health center Medicaid patients have lost coverage, according to a survey from NACHC and George Washington University.
• About 18% of child community health center patients lost Medicaid coverage, as well as 27% of patients with chronic illnesses, according to NACHC.
• More than 50% of community health center patients who were disenrolled from Medicaid have discontinued or postponed treatments, missed an appointment, or lost access to specialty and/or hospital care, according to NACHC.
• Roughly 70% of people who lost Medicaid coverage were disenrolled due to procedural reasons, according to NACHC. That means those patients weren’t necessarily ineligible for Medicaid coverage but may have lost it due to factors like not understanding what steps needed to be taken to renew coverage, according to KFF.

The consequences of disenrollment: Not only do patients lose access to necessary healthcare but also community health centers, which now have a growing number of uninsured patients, face higher overall costs to provide care, according to NACHC.

The trade group also said the unwinding process has created a heavier workload for workers at community health centers because they spend time helping patients navigate the enrollment process or find other insurance options.

Community health center workers have reported spending an average of 1,600 hours helping patients figure out their Medicaid eligibility and navigate the enrollment process, according to NACHC.

In August 2022, the Department of Health and Human Services predicted that roughly 15 million people would lose Medicaid coverage as part of the unwinding process—a figure that’s already been far surpassed.

“We all suffer when people lose their Medicaid coverage with broad, deep, and long-standing impacts across families, communities, and the public health and healthcare system,” Rhee said in a statement.