By: David Ostrowsky

That millions of Americans have been losing Medicaid coverage over the past year may be unsurprising, but it doesn’t make it any less heartbreaking.

Some historical context: Normally, Medicaid recipients who receive federally funded health insurance due to disabilities or low incomes undergo eligibility reviews every year to see if they are eligible for renewed coverage. But, of course, March 2020 was far from a normal time and the feds froze the checks due to it being a public health emergency. Subsequently, Medicaid recipients would retain their enrollment for the following three years . . . until this past spring when President Biden terminated the public health emergency and an “unwinding” process soon ensued whereby millions have thus far been disenrolled from Medicaid.

According to KFF, the renowned non-profit organization that bills itself as an independent source for health policy research, polling, and journalism, as of December 20, 2023, over thirteen million Americans had been taken off Medicaid since the spring. Texas, perhaps understandably given its mammoth size, has been at the epicenter of this gargantuan development. Since the COVID-era coverage protections were stripped last spring, over two million Texans have been cut off from their state’s Medicaid program. For reference, Houston, Texas’ largest city population-wise, has 2.3 million residents. It also should be noted that Texas hasn’t finished assessing eligibility information for all Medicaid enrollees, meaning more residents will likely forfeit coverage. Nationwide, an untold number of Medicaid beneficiaries will be receiving such disheartening notifications through May, after which the pre-pandemic status quo is slated to resume. 

While there is not exactly a universal way to categorize the tens of millions who receive Medicare funds, some common profiles include:

--Single parents working multiple low-paying jobs while struggling to stay above the Federal Poverty Level

--Parents with children who have serious, perhaps even terminal, illnesses that require incredibly expensive, drawn-out treatment

--Americans who may be unable to work in a full or part-time capacity due to incurring sudden debilitating injuries

The harsh reality is that for many of these Medicare recipients who lack robust employer-sponsored health benefits, being denied coverage – even for just a few weeks – can represent a life-or-death scenario (i.e., no longer having access to chemotherapy, radiation, and/or round-the-clock medical care.)

In fairness, Texas officials have been responsive to outreach efforts on behalf of the Center for Medicaid and Children’s Health Insurance Program Services (CHIP) as they convened to review Texas’ eligibility evaluation procedures and examine cases of state residents becoming disenrolled. Ultimately, Texas reinstated over 90,000 people who were deemed falsely disenrolled from Medicaid.

In a statement to NBC News, the Texas Health and Human Services Commission said it “planned this massive unwinding effort for more than a year,” and that if issues surfaced, the commission “works systematically to resolve any issues and reinstate recipients’ coverage if necessary.” And even for those who do not get coverage reinstated, it’s not Medicaid or nothing – there is also potential to qualify for no or low-cost premiums in the health insurance marketplace or obtain coverage from a new employer.

Also in fairness, for virtually every single American alive, this decade’s pandemic was an unprecedented time in our country’s history with many systems, including Medicaid, being thrown out of whack. From spring 2020 to spring 2023, Medicaid enrollment spiked to historic highs (as in over ninety-seven million Americans) – a situation that may very well have been unsustainable going forward. This spring, meanwhile, state agencies will have their hands full playing catch-up in examining cases to determine who should and should not retain Medicaid coverage.

On another level, this historic purge of Medicaid recipients has exposed longstanding administrative and technical problems in the systemic framework that covers the most vulnerable Americans. As New York Medicaid director Amir Bassiri recently told a national board of Medicaid advisers: “It would be a failure if we come out of this with the same old standards and processes we had in place prior to the public health emergency.” These antiquated standards and processes very well prevent many from enrolling (and re-enrolling) in Medicaid in the first place.

For now, such shortcomings – not to mention persistent staffing challenges -- are also making it significantly harder for states to redetermine who is Medicaid eligible.