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Behind the Medicaid disenrollment numbers

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Sep 26, 2023

Illustration: Shoshana Gordon/Axios

More than 7 million people have been disenrolled from Medicaid since the unwinding began, per KFF, but there's a lot we still don't know about what that estimate tells us — including who's truly ineligible for the program and how many are likely to become uninsured.

Why it matters: The U.S. hit a record-low uninsured rate earlier this year, but it's almost certainly going to tick back up after states finish the process.

Driving the news: The Biden administration said last week that 500,000 people who improperly lost Medicaid coverage will have their insurance restored, and ordered the states that made the technical errors to stop disenrolling people for procedural reasons until glitches have been fixed.

  • But this only addresses one way in which people are losing Medicaid coverage, versus having actually been determined to be ineligible.
  • Procedural issues have been the reason for 73% of coverage terminations, per KFF, and those people may still be eligible for the program.

The big picture: "People are being dropped from Medicaid quicker and in larger numbers than I expected," said KFF's Larry Levitt.

  • "The share of disenrollments due to procedural bureaucratic reasons is still quite high. I would have hoped that would diminish more over time, but that hasn't really happened yet," he added.
  • Levitt said it will help when states stop determining eligibility at the family level rather than for individuals — but "there are still many other ways in which Medicaid enrollees are getting caught up in red tape."

By the numbers: There's some early data on how many people losing Medicaid are transitioning to Affordable Care Act marketplace coverage.

  • According to CMS data, only 7.5% of people who lost Medicaid coverage in April selected a marketplace plan. In May, that number inched up to 8.3%, as Georgetown University's Edwin Park noted in a Center for Children and Families blog post.
  • HHS had projected before the unwinding began that about 18% of the 15 million people it expected to lose Medicaid coverage would be eligible for subsidized marketplace coverage — which, of course, isn't the same as actually enrolling.
  • "In general, it gives you a sense that in the first months of unwinding, very few people who were losing Medicaid coverage were turning around and applying to the marketplaces and selecting a plan," Park said.

Zoom in: Idaho has already completed its redetermination process.

  • Of the roughly 154,000 people who were protected from losing coverage during the pandemic, only about 32,000 — or roughly 21% — were found to still be eligible, according to an Idaho Department of Health and Welfare press release.
  • "Of those who were determined ineligible, 30% obtained coverage through the state's health insurance marketplace," the press release adds.
  • Greg Stahl, a spokesperson for the Idaho Department of Health and Welfare, said the number refers to those who were determined ineligible for Medicaid, not people who lost coverage for procedural reasons, per information from the marketplace.

The bottom line: We're still missing a lot of information about who is getting their coverage terminated and what kind of coverage, if any, they'll have going forward.

  • "It's our assumption that a large, large majority of those who have lost Medicaid — particularly among kids ... likely are remaining eligible," Park said.
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