Over 1 million people in 21 states disenrolled from Medicaid 

Photo: Luis Alvarez/Getty Images

At least 1,149,000 Medicaid enrollees have been disenrolled as of June 14, based on data from 21 states, according to the latest numbers from KFF.

Thirty-eight percent of people with a completed renewal were disenrolled in reporting states, while 62%, or 1.9 million enrollees, had their coverage renewed. Three of the 21 reporting states do not provide data on renewed enrollees, KFF said. 

Because not all states have publicly available data on total disenrollments, the data reported undercounts the actual number of disenrollments, KFF said.

WHY THIS MATTERS

Each state operates its own Medicaid program within federal guidelines. 

During the COVID-19 public health emergency, Medicaid numbers grew due to the continuous enrollment requirement that kept people covered. State funding for the Medicaid program was enhanced by federal funds during the PHE. But the Consolidated Appropriations Act, 2023 phased down the enhanced federal Medicaid matching funds through December 2023, according to KFF.

States no longer had the federal funds to support the enrollment of individuals who no longer qualified for Medicaid.

The federal government allowed states to begin Medicaid redeterminations on April 1, ahead of the announced end of the PHE on May 11.

Individuals no longer eligible for Medicaid could sign up for Affordable Care Act coverage under a special enrollment period opened by the Centers for Medicare and Medicaid Services for that purpose. The number of people who have taken advantage of the SEP is unknown.

Millions were expected to lose Medicaid coverage. Many were still eligible, but unaware they needed to re-enroll.

More than two-thirds, 76%, of individuals who had Medicaid coverage during the pandemic, had their coverage terminated for procedural reasons, according to KFF data.

This leaves hospitals facing uncompensated care from over one million patients who are no longer covered by Medicaid.

Earlier this week, Health and Human Services Secretary Xavier Becerra sent a letter to governors urging them to adopt new flexibilities to minimize avoidable Medicaid coverage losses among children and families.

THE LARGER TREND

There is wide variation in disenrollment rates across reporting states, ranging from 73% in Idaho to 16% in Virginia. 

Differences in who states are targeting with early renewals, as well as differences in renewal policies and systems capacity likely explain some of the variation in disenrollment rates, KFF said. Some states are initially targeting people early in the unwinding period who they think are no longer eligible or who did not respond to renewal requests during the pandemic, but other states are conducting renewals based on an individual's renewal date.

Additionally, some states have adopted several policies that promote continued coverage among those who remain eligible, and they have automated eligibility systems that can more easily and accurately process renewals. Other states have adopted fewer of these policies and have more manually-driven systems.

There is also wide variation in rates of procedural disenrollments across states reporting this breakout, ranging from 89% in Kansas to 33% in Colorado. Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process. They can occur when the state has outdated contact information, or because the enrollee does not understand or does not complete renewal packets within a specific time frame. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage, KFF said.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org