It’s the first anniversary of the Medicaid unwinding for many states, a process that kicked off when federal rules that had kept people on Medicaid and the Children’s Health Insurance Program (CHIP) through the pandemic expired. And while states could redetermine eligibility again, things have “unwound” more than some experts predicted. Children were kicked off the rolls at higher rates than adults, according to a new study the Urban Institute released May 2. Twelve states—Montana, Iowa, South Dakota, Alabama, Idaho, Georgia, Texas, Arkansas, Oklahoma, Florida, Mississippi, Colorado—exceeded 100% of their total projections for disenrolling children.
Eight states—South Dakota, New Hampshire, Texas, Arkansas, Iowa, Idaho, Montana, and Oklahoma—also exceeded 100% of their total projections for disenrolling both adults and children.
Experts following the process expected to see some states with more disenrollments, but they didn’t realize so many of those losing coverage would be children, Katherine Hempstead, a senior policy advisor at the Robert Wood Johnson Foundation, said.
“That’s been kind of a bad surprise of the unwinding experience writ large,” Hempstead told Healthcare Brew. “Those sorts of unexpected disenrollment of children were more likely in states that appeared to be prioritizing speed over accuracy in their approach to the process.”
Why are the numbers so high?
At least 21 million Medicaid beneficiaries have been removed as of May 1, based on the most current data from all 50 states and Washington, DC, KFF reported.
While some of these individuals lost eligibility, most still qualified but hit procedural hurdles like not submitting their renewal applications on time because of miscommunications, Hempstead said. Technological complications have also played a part: At one point, as Healthcare Brew previously reported, at least 500,000 recipients (mostly children) lost coverage because of software errors.
“The fact that we’ve seen so many children disenrolled suggests that there are a lot of disenrollments happening for reasons unrelated to actual changes in eligibility,” Hempstead said.
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The study also shows a clear association between the speed of states and the way their process has played out, she said.
“The states that—it’s not a surprise, but sort of confirmatory—that were like, ‘Oh, the most important thing is to do it fast,’ are the states where a lot of people lost coverage,” Hempstead said.
Texas leads the country in disenrollments, with more than 2 million individuals removed from coverage to date, per KFF data, and it has been one of the states to move faster, Hempstead said. It’s already seen some direct consequences of these policies at its community health centers, which serve patients regardless of their ability to pay or insurance coverage status.
“When people, especially low-income people, are separated from their health insurance, they start to become really terrified to seek care because they don’t know what kind of a bill they’re going to get,” Hempstead said.
Representative Lloyd Doggett, a Texas Democrat, who has criticized his state’s leaders over their handling of the unwinding, told Healthcare Brew in a statement that the study “paints a shocking picture of how awful the implementation of the Medicaid unwinding process is nationwide.”
But ultimately, the study reflects something states will have to confront in the future: a “seismic” drop in people receiving medical care, Hempstead said.
It’s too soon to know the widespread health effects of these policies, she said, but pediatrics would be a good place to start looking.
“Children are supposed to have frequent, regular visits, so you can start looking at missed child wellness exams, missed vaccinations,” she said. “All the kinds of important things that children will miss when they don’t have coverage.”