Between 5.3 and 14.2 million people could lose Medicaid coverage at the end of the PHE
Hospitals could face a greater number of uninsured patients as facilities remain financially strained by the COVID-19 pandemic.
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Between 5.3 million and 14.2 million low-income people could lose Medicaid coverage following the end of the public health emergency, KFF researchers find in a new analysis. The end of the PHE, currently scheduled for mid-July, would end the federal continuous enrollment requirement on August 1.
This comes at a time when Medicaid enrollment has grown during the COVID-19 pandemic. Enrollment is expected to see a growth of about 25%, or 22.2 million enrollees, from 2019 through 2022, mainly due to the continuous enrollment requirement in place during the public health emergency.
KFF analysts project that, from fiscal year 2020 through fiscal year 2022, states will have collectively spent $47.2 billion to cover additional people enrolled in Medicaid because of the continuous enrollment requirement, and will have received $100.4 billion in new federal funds to cover those costs and provide general fiscal relief through enhanced Medicaid matching funds.
Based on the analysis, KFF estimates that enrollment will have risen to a projected 110.3 million by the end of 2022. That would be 22.2 million more people than were enrolled in 2019, before the pandemic.
In the new analysis, KFF researchers examine two potential scenarios based on these survey results, estimating that a 5% decline in Medicaid enrollment would translate into a decline of 5.3 million enrollees, and a 13% decline in Medicaid enrollment would translate into a decline of 14.2 million enrollees.
The biggest losses are expected to be among adults made eligible for coverage by the Affordable Care Act's Medicaid expansion, other adults eligible for Medicaid not due to a disability, and children, since these were the groups that experienced the largest increase during the pandemic.
Researchers did not examine how many of the people who lose Medicaid might be able to find coverage from other sources such as the ACA marketplace, how many might become uninsured and how many might still be eligible for Medicaid, but face barriers in retaining coverage.
WHY THIS MATTERS
The end date of the PHE will have significant implications for Medicaid enrollment and spending, KFF said. When the continuous enrollment requirement ends, states will begin processing redeterminations and renewals. States will largely be responsible for managing the unwinding of the continuous enrollment requirement, which could lead to variation in practices and in how many people are able to maintain Medicaid coverage.
Hospitals and other providers could face greater numbers of uninsured patients, at a time when they are continuing to deal with the COVID-19 pandemic, both financially and clinically.
Infection rates have been growing due to Omicron variants and this has translated into an increased number who need hospital care.
On average, nearly 2,400 virus-positive Americans are being admitted to hospitals each day, up by 17% in the last week, according to federal data reported by ABC News. Forty-one states and territories have reported increases of 10% or more in their daily number of COVID-19-related hospital admissions, the report said.
THE LARGER TREND
A KFF survey of state Medicaid directors in February 2022 found that median Medicaid enrollment would decline by 5% next year following the end of the public health emergency.
Another KFF survey from January 2022 found that states expect an average of about 13% of Medicaid enrollees to be disenrolled following the end of the continuous enrollment requirement (with estimates ranging from 8% to over 30%).These recent survey results illustrate the great deal of uncertainty surrounding the ways states will implement the end of the continuous enrollment requirement, and how many individuals will lose coverage.
In exchange for abiding by the continuous enrollment requirement, states became eligible for a 6.2% bump in the federal Medicaid match rate (FMAP) to help them manage rising enrollment and rapidly provide broader fiscal relief by allowing states to reduce state Medicaid spending at a time when states experienced significant drops in revenue early in the pandemic.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
