1 In 8 Enrollees Exited Medicaid During Redeterminations In 4 Southern States: Study

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Dive Brief:

• One in eight people on Medicaid reported losing coverage under the safety-net insurance program about six months into redeterminations in four Southern states, according to a study published in JAMA Health Forum.
• About half of the survey respondents who were unenrolled from Medicaid became uninsured in Arkansas, Kentucky, Louisiana and Texas, according to the study. Twenty-seven percent had employer-sponsored insurance at the time of the survey, and the rest found other coverage. 
• Those who lost Medicaid coverage during redeterminations reported higher rates of delays and affordability challenges when trying to access care, according to the survey. 

Dive Insight:

Enrollment in the insurance program for low-income Americans swelled during the COVID-19 pandemic, spurred by policies that kept beneficiaries covered by Medicaid during the public health emergency. 

But that period of continuous enrollment ended last spring, and states began rechecking eligibility for their Medicaid rolls. More than 23 million people have since been removed from the program, according to health policy research firm KFF.

The unwinding process has hit snags. Last year, federal regulators paused disenrollments in some states due to high levels of improper removals and threatened to cut funding to those that failed to comply with reporting or eligibility requirements. 

Some states have also disenrolled more people than expected, suggesting some beneficiaries are being cut from the rolls who are still eligible for the safety-net program, according to an analysis published in May.

The latest survey, which included more than 2,000 low-income people in Arkansas, Kentucky, Louisiana and Texas, found state policy choices are linked to different levels of coverage loss — and beneficiaries faced increased barriers to care once they were removed from Medicaid. 

More than half of adults who were disenrolled reported cost-related delays in care, compared with 27% of people who remained in Medicaid. Nearly 45% of those who were removed from the program said they had delayed or skipped doses of medications due to cost, compared with about 27% of people who stayed enrolled.

However, since the survey focused on low-income people, it’s likely many people who became uninsured are still eligible for Medicaid or quality for subsidies to buy insurance through the Affordable Care Act marketplaces. 

Fewer than 1 in 10 respondents who lost coverage had an exchange plan, suggesting more outreach and assistance is needed to help them move into ACA coverage, the study’s authors wrote. 

Disenrollments also varied significantly across states. Disenrollment was highest in Arkansas, which began the unwinding process earlier and on an accelerated timeline, according to the research. Texas also had a high disenrollment rate, possibly because the state has yet to expand Medicaid and began determining eligibility first for people who were likely ineligible.

“The lowest disenrollment rates were in Kentucky and Louisiana, which are expansion states that spread their renewals over the full year and used outside data sources to limit the burden on beneficiaries to demonstrate ongoing eligibility,” the researchers wrote.