What happens after people lose Medicaid coverage?

In the beginning of the pandemic, Congress enacted the Households First Coronavirus Response Act (FFCRA), which included non permanent situation Medicaid packages hold individuals continually enrolled, and in return, states have acquired enhanced federal funding. Underneath the continual recording clause, Medicaid enrollment It has grown exponentially in comparison with what it was earlier than the pandemic and the patriotism Uninsured price had refused. provisions contained in Consolidated Appropriations Act (CAA). To retract latest positive factors in medical insurance protection.

The important thing query is whether or not individuals who lose Medicaid will be capable of switch to and retain different types of protection, together with Inexpensive Care Act (ACA) market plans with premium help or employer-sponsored well being advantages.

This abstract makes use of pre-pandemic information from the 2016-2019 Medicaid Expenditure Panel Survey (MEPS) to look at how effectively individuals enrolled in and retained different protection within the 12 months after de-enrolling in Medicaid/CHIP. See the “Strategies” part on the finish of this temporary for extra particulars. Key findings embrace:

  • Within the 12 months following disenrollment from Medicaid/CHIP, practically two-thirds (65%) of individuals had skilled a interval of uninsurance.
  • Practically 4 in ten (41%) individuals who drop out of Medicaid/CHIP finally re-enroll in Medicaid/CHIP inside a 12 months (or “Shake, stir violently“).

Major findings

Within the 12 months following disenrollment from Medicaid/CHIP, practically two-thirds (65%) of individuals had a interval of uninsured whereas solely 35% had been constantly enrolled in protection (Determine 1). The 65% of Medicaid/CHIP enrollees who skilled uninsured post-withdrawal consisted of people that had been: uninsured all 12 months (17%), uninsured for a number of the 12 months and had one other supply of protection in the course of the 12 months (16%) and uninsured He had after de-enrolling however finally re-enrolled in Medicaid/CHIP (or “churn”) earlier than the tip of the 12 months (33%). The 35% of Medicaid/CHIP enrollees who maintained protection for a full 12 months after de-enrollment in Medicaid/CHIP consisted of people that: had been enrolled in one other supply of protection for your complete 12 months (26%) and had one other supply of protection for a number of the 12 months but additionally re-enrolled in Medicaid/CHIP earlier than the tip of the 12 months (9%). Notably, most individuals who had been lined for the total 12 months after deenrollment had an overlapping interval of protection earlier than they misplaced Medicaid/CHIP throughout that point that they had each Medicaid/CHIP and personal medical insurance.

Practically 4 in ten (41%) individuals who choose out of Medicaid/CHIP will finally go on to re-enroll in Medicaid/CHIP inside a 12 months (Determine 2). This group consists of people that re-enroll in Medicaid/CHIP after a interval of not being insured (33%) and who re-enroll after getting different protection (9%). Of all enrollees who signed up, 79% had been uninsured previous to their Medicaid/CHIP re-enrollment. Claudication happens for a number of causes. These enrolled might face short-term modifications in revenue that make them quickly ineligible. Disruption may happen when people who find themselves nonetheless eligible for Medicaid/CHIP lose protection for administrative causes, reminiscent of difficulties finishing annual renewals. Finally, Medicaid/CHIP on and off can limit entry to care and result in delays in acquiring wanted care. Even for individuals who had different protection previous to re-enrolling in Medicaid/CHIP, disruption may cause protection disruptions when it requires individuals to vary well being care suppliers or cycle by totally different profit packages.


These findings spotlight that many individuals don’t switch to and keep different protection after opting out of Medicaid/CHIP. General, 65% of individuals had a protection hole in the course of the 12 months after de-enrolling in Medicaid/CHIP and solely 26% of individuals enrolled and saved one other supply of protection for a full 12 months after shedding Medicaid/CHIP protection. Of people that disenroll from Medicaid/CHIP, 41% re-enrolled in the course of the 12 months. This quantity consists of the 33% who re-enroll in Medicaid/CHIP after a interval of not being insured, indicating that many individuals had been nonetheless eligible once they misplaced Medicaid/CHIP protection. Even amongst individuals who initially enrolled with different protection, 34% didn’t hold it for your complete 12 months; These people finally misplaced their different protection (and have become uninsured) or re-enrolled in Medicaid/CHIP. General, individuals in our evaluation who had overlapping protection (eg, Medicaid/CHIP and particular protection) previous to shedding Medicaid/CHIP had been much less prone to grow to be uninsured or grow to be pressured in comparison with those that didn’t have overlapping protection.

KFF estimates That between 5 and 14 million individuals will lose Medicaid protection when states “unwind” the supply of steady enrollment this 12 months. Beginning April 1, 2023, states can attraction de-enrollment for the primary time since March 2020. Some people who find themselves de-enrolled throughout class can be ineligible and grow to be uninsured if they don’t switch to different protection. Others will lose protection for administrative causes although they’re nonetheless eligible. Whereas the hundreds of thousands of people that misplaced protection in the course of the leisure course of would face comparable challenges to these included on this evaluation, there are additionally essential variations immediately. For instance, Congress they expanded ACA market-enhancing subsidies, which had been first included within the American Rescue Plan Act (ARPA) in the course of the pandemic, making these plans extra reasonably priced till 2025. As well as, because of the provision of steady registration, growing quantity of these enrolled in Medicaid immediately additionally point out they’re enrolled in personal insurance coverage than they had been earlier than the pandemic, which reduces protection disruptions for these people once they choose out of Medicaid. Nevertheless, that is solely a subset of the individuals who can be deregistered in the course of the dismantling course of. Most people who will lose out on Medicaid whereas disengaged as a result of they now not qualify will nonetheless have to switch to (and keep) different medical insurance to keep away from a protection hole.

State Medicaid businesses and different stakeholders can take motion a number of steps To scale back protection disturbances and flopping throughout cooldown. Usually, these actions may embrace enhancing state eligibility methods, streamlining renewal procedures, speaking with registrants about the necessity to full renewals, and facilitating transition to the ACA market or separate CHIP protection for people who find themselves discovered to not qualify for Medicaid. issued by the federal authorities steerage Supposed to scale back protection disruptions for Medicaid enrollees/CHIP imposed Reporting necessities To observe the dismantling of states. Though our evaluation gives a pre-pandemic baseline for people’ medical insurance modifications after shedding Medicaid/CHIP protection, state jaw insurance policies could have a big affect on whether or not individuals can be extra profitable in transitioning to different protection after shedding Medicaid than they’d before- Epidemiological tendencies.

information supply

This evaluation makes use of information from the Medical Bills Panel Survey (MEPS). flaps 21, 22 and 23, collected between 2016 and 2019. MEPS panels typically cowl a two-year interval (24 months), though Panel 23 was prolonged by a further 12 months because of the coronavirus pandemic. Our evaluation used solely the primary two years (24 months) from Panel 23. Our estimates are consultant of the MEPS survey design and use of longitudinal weights. We used month-to-month insurance coverage variables to find out Medicaid enrollments and medical insurance outcomes over the examine interval.

Examine populations and exceptions

We restricted our evaluation to people who had been disenrolled from Medicaid/CHIP throughout the first 13 months of the survey panel to permit for a full 12-month follow-up interval. We additionally restricted the evaluation to individuals who had a minimum of 4 consecutive months of Medicaid/CHIP previous to disenrollment to exclude anybody who was enrolled underneath presumed eligibility or for emergency providers however was then decided to be ineligible. We excluded individuals age 65 and older who had been youthful than age 65 with Medicare as a result of Medicare is the first driver of acute care when individuals have each Medicare and Medicaid. Lastly, we excluded a small variety of people who had been so exterior the scanning vary Throughout the examine interval (for instance, if somebody dies, strikes in another country, or turns into institutionalized). After these exceptions, the ultimate pattern included 1,160 contributors.

medical insurance standing

For every month in the course of the panel, we generated an index that categorized people as both enrolled in Medicaid; get protection aside from Medicaid; or not insured. For individuals on Medicaid, we additionally created one other indicator that identifies whether or not people have a secondary supply of protection whereas enrolling in Medicaid. Notably, in 2018, MEPS modified how they requested Well being protection questions For people who stay in the identical family as the first respondent. Well being protection questions as much as 2018 had been requested on the family degree (eg, “Has anybody within the family been lined by…?”), however the questionnaire has been up to date to ask these questions on the particular person degree (eg, “Has anybody within the family been lined by…?” Particular person 1 lined by…?”). Nevertheless, we count on the change to have little impact on how respondents report medical insurance protection for members of the family.

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