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That puts them at higher risk for severe disease if they get infected and for exorbitant medical bills if they lose their insurance. COVID vaccination rates among Medicaid enrollees are lower than those of the general population in multiple states. In general, being uninsured can limit access to medical care. Low-income people could still be in crisis when the public health emergency ends, said Stephanie Burdick, a Medicaid enrollee in Utah who advocates on behalf of patients with traumatic brain injuries. "Even short-term disruptions can really upend a family," said Jessie Mandle, deputy director of Voices for Utah Children, an advocacy group. Most might qualify for insurance through government programs, the ACA insurance marketplaces, or their employers - but the transition into other coverage isn't automatic.

Still, officials and groups who work with people living in poverty worry that many low-income adults and children - typically at higher risk for health problems - will fall through the cracks and become uninsured. However, she said, "we're not going to compromise people's access to care for that reason." She said that processing all the eligibility redeterminations takes at least nine months and that the end of the federal funding bump will add pressure to move faster. "Whether they didn't receive a renewal or they've moved, we don't know what those reasons are."Īrizona Medicaid director Jami Snyder said 500,000 people are at risk of losing Medicaid for the same reasons. "More often than not, it's those that just simply have not returned information to us," he said. He said that 80% to 90% of those people were at risk because of incomplete renewals. In January the eligibility of roughly 120,000 people in Utah, including 60,000 children, was in question, according to Jeff Nelson, who oversees eligibility at the Utah Department of Health. "We want to do everything possible to minimize that." In Medicaid, "typically, there's always been some amount of folks who lose coverage for administrative reasons for some period of time," said Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services. In Colorado, officials expect they'll need to review the eligibility of more than 500,000 people, with 30% of them at risk of losing benefits because they haven't responded to requests for information and 40% not qualifying based on income. But the money will dry up soon after the end of the public emergency - and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.

Congress gave states billions of dollars to support the coverage requirement. The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. As this tsunami of work approaches, many state and local offices are short-staffed. State Medicaid agencies often send renewal documents by mail, and in the best of times letters go unreturned or end up at the wrong address. In Texas, which has not expanded its program, adults without children don't qualify for Medicaid. For example, in 2021 a single adult without children in Virginia - a state that expanded Medicaid under the Affordable Care Act - had to earn less than $1,482 a month to qualify. However, income limits vary by state and eligibility group. Medicaid provides coverage to a vast population, including seniors, the disabled, pregnant women, children, and adults who are not disabled. Department of Health and Human Services can extend the public health emergency in 90-day increments it is currently set to end April 16. People could lose their coverage if they earn too much or don't provide the information their state needs to verify their income or residency. When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person's eligibility and connecting with people whose jobs, income, and housing might have been upended in the pandemic. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare & Medicaid Services. While those routines have been suspended for the past two years, enrollment climbed to record highs. State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.īefore the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. Many others are bound to get lost in the transition. Some might sign up for different insurance. The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends.