Black and Latino Medicaid enrollees have been twice as likely as white enrollees to lose Medicaid coverage because of an inability to complete renewal forms over the past year, researchers have concluded in an article published in JAMA Internal Medicine online on June 3. The article, “Racial and Ethnic Disparities in Medicaid Disenrollment After the End of the COVID-19 Public Health Emergency,” was written by Kranti C. Rumalla, Daniel B. Nelson, M.D., K. John McConnell, Ph.D., and Jane M. Zhu, M.D.
“Continuous Medicaid enrollment during the COVID-19 public health emergency (PHE) led to record enrollment of 94 million individuals and decrease in uninsurance,” the authors wrote. “Since the continuous enrollment provision ended March 31, 2023, approximately 10 million people have lost Medicaid coverage as states began redetermining enrollees’ Medicaid eligibility (unwinding period). Three-quarters of disenrollments occurred for procedural reasons, including incomplete applications, application errors, and inaccurate contact information.”
As The New York Times’s Noah Weiland wrote on June 3, “The findings from researchers at the Oregon Health & Science University, Harvard Medical School and Northwestern University are some of the first comprehensive data on race gathered after a pandemic-era policy that allowed Medicaid recipients to keep their coverage without regular eligibility checks ended last year. More than 22 million low-income people have lost health care coverage at some point since April 2023, when the policy allowing continuous enrollment lapsed. The process of ending that policy — what federal and state officials have called ‘unwinding’ — was one of the most drastic ruptures in the health safety net in a generation.”
“Medicaid eligibility is complex, and then applying and keeping Medicaid coverage is a huge logistical barrier,” Dr. Jane M. Zhu, an associate professor of medicine at the Oregon Health & Science University and one of the study’s authors, told Weiland in an interview. “What this analysis is showing is that these barriers have downstream spillover effects on particular communities.”
A provision in a coronavirus relief package passed by Congress in 2020 required states to keep recipients of the joint federal-state health insurance program for the poor continuously enrolled in exchange for additional federal funding. By early 2023, more than 90 million people were enrolled in Medicaid and the Children’s Health Insurance Program, or more than one in four Americans. That was up from about 70 million people at the start of the coronavirus pandemic. About half of Medicaid enrollees are Black or Latino, and around 40 percent are white.
State-level data on the causes of these disenrollments is not very widespread, with only nine states currently reporting disenrollments by race and ethnicity, the authors noted. To overcome this, they used data that was publicly available from the U.S. Census Bureau's Household Pulse Survey, conducted between March 29 and October 2, 2023, to estimate adult Medicaid disenrollment by race and ethnicity during the Medicaid unwinding period. The findings revealed that individuals identifying as Black and Hispanic were twice as likely as white people to report losing Medicaid coverage due to difficulties in completing the renewal process.
As of May, Medicaid enrollment had declined by more than 13 million, including more than five million children, according to the Georgetown University Center for Children and Families, a unit within the Georgetown University McCourt School of Public Policy.The Center for Children and Families noted that, “As of March 2023, more than 35.1 million children were enrolled in Medicaid and approximately 4.3 million were enrolled in Medicaid coverage funded by CHIP—more than half of all U.S. children. Children are eligible for Medicaid coverage, or for coverage in the state’s separate CHIP program, at much higher family income levels than adults so they are more likely to remain eligible during the unwinding process. However, children are also more likely to be disenrolled for procedural reasons and to experience gaps in coverage before re-enrolling back onto Medicaid. Because children of color make up a disproportionate share of Medicaid enrollees and may face additional barriers to maintaining coverage, disenrollments may widen racial and ethnic disparities in health insurance coverage and restrict access to care. Last year, CCF estimated that as many as 6.7 million children could experience a period of uninsurance as a consequence of the unwinding.”
Further, the Center for Children and Families noted, “CCF researchers are tracking changes in Medicaid enrollment during the unwinding process to monitor health coverage losses for children. To capture data in near-real time, CCF uses enrollment data posted by states on their websites because those data are generally more timely than federal sources. However, not every state posts enrollment data. Some states may release additional data, such as disenrollments, in unwinding-specific data reports or state dashboards but the map and charts below do not include those sources of other data. The Centers for Medicare & Medicaid Services (CMS) also publishes monthly state enrollment numbers with a lag of several months. We use the CMS enrollment data for states that do not post their own data directly as it becomes available.”
The new study’s authors are urging policymakers to enhance Medicaid enrollment processes to address health disparities, through the transparent reporting of race and ethnicity data, streamlined administrative procedures, expanded renewal assistance, and prioritized redeterminations for beneficiaries most likely to be ineligible.
"Addressing these barriers may include more transparent race and ethnicity data reporting, expedited administrative processes, expanded renewal assistance, and prioritized redeterminations for beneficiaries most likely to be ineligible," the researchers wrote.
