Though millions of Americans are expected to be kicked off of Medicaid in coming months, they don’t all have to be left uninsured.
But it could take some work to regain health coverage.
“For a lot of people, this can be a very disruptive period of time,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “There is a significant time and paperwork burden being placed on families – a lot of them very low income, a lot of them medically vulnerable.”
States are now free to terminate the Medicaid coverage of residents they deem ineligible. States had been barred from involuntarily removing anyone for the past three years as part of an early congressional Covid-19 pandemic relief package, causing enrollment in Medicaid and the Children’s Health Insurance Program to balloon to more than 92 million people.
Of the roughly 15 million people who could lose Medicaid coverage over the next 14 months, about 8.2 million would no longer qualify, according to a Department of Health and Human Services analysis released in August.
Some 2.7 million of these folks would qualify for enhanced federal subsidies for Affordable Care Act policies that could bring their monthly premiums to as low as $0.
Another 5 million are expected to secure other coverage, mainly through employers.
Some 6.8 million people, however, will be disenrolled even though they remain eligible for Medicaid.
What to consider if you lose Medicaid coverage
Check out Obamacare policies: Folks who lose their Medicaid coverage can shop for health insurance plans on the Affordable Care Act exchanges.
Those whose annual incomes remain below 150% of the federal poverty level – $20,385 for a single person and $41,625 for a family of four in 2023 – can obtain enhanced federal assistance to lower their premiums to as little as $0 a month. That beefed-up subsidy is in place through 2025.
Many people with higher incomes can find subsidized policies for $10 or less.
State Medicaid agencies are tasked with easing residents’ transfer from Medicaid to the Obamacare marketplaces, but the smoothness of the process will vary greatly by state. Once someone is determined to no longer qualify for Medicaid, the agency must assess his or her eligibility for Affordable Care Act coverage and transfer the resident’s information to the exchange.
Some states that run their own Obamacare exchanges are taking extra steps to ensure their residents remain covered. Rhode Island, for instance, is automatically enrolling certain people in marketplace coverage. It’s also paying the first two months of premiums for some residents who actively select policies.
Those who lose Medicaid coverage and live in the 33 states covered by the federal marketplace, healthcare.gov, can apply for Affordable Care Act policies through a special enrollment period that runs through July 2024. State-based exchanges have their own deadlines, with some mirroring the federal exchange and others providing much shorter windows.
Navigators and insurance brokers can help consumers select plans.
Historically, very few people who lose Medicaid coverage wind up in Obamacare plans. About 4% of adults who were terminated from Medicaid enrolled in exchange policies in 2018, according to the Medicaid and CHIP Payment and Access Commission.
The coverage differs too. Those that switch to the marketplace may have to find other doctors that are in their insurers’ networks and may face out-of-pocket costs.
Consider job-based coverage: A number of people who are terminated from Medicaid may already be covered by their employers, particularly those who started new jobs during the pandemic. Others have the option of obtaining coverage through work, though it will almost certainly be more expensive than Medicaid since it will likely entail premiums, deductibles and copays.
Workers may find they can afford coverage for themselves but not for their families. If the premiums for family policies cost more than 9.12% of household income, spouses and children may be able to get subsidized coverage on the Affordable Care Act exchanges.
Employees should contact their human resources departments to sign up. Typically, they’ll have to enroll within 60 days of losing Medicaid, but those who are terminated from the program between now and July 10 will have until early September to sign up.
See if you or your children remain eligible for Medicaid: Millions of Americans who still qualify for Medicaid may lose coverage for procedural reasons. For example, they may have moved so they don’t receive the redetermination notices. Or they may not return the necessary paperwork to prove their eligibility.
So it’s crucial that folks update their contact information with their state agencies and reply to the letters they receive about renewing their Medicaid eligibility.
“When you get that packet in the mail, respond to it promptly,” Corlette said.
Those who are dropped have 90 days to submit their renewal paperwork to their state agency, which is required to reinstate them if they are found eligible. Beyond that time period, people may reapply. In most states, your coverage can be made retroactive for up to three months if you were eligible and received Medicaid-covered services.
Parents who no longer qualify and are terminated should check if their children remain eligible. As many as 6.7 million kids are at risk of losing Medicaid coverage, according to Georgetown’s Center for Children and Families.
Nearly three-quarters of the children projected to be dropped will remain eligible for Medicaid or CHIP but will lose coverage mainly because of administrative issues. Black and Latino children and families are more likely to be erroneously terminated, according to the center.