For months, public health experts have been sounding the alarm over many Medicaid enrollees losing their coverage with the winding down of the COVID-19 public health emergency.

But that hasn't stopped thousands from being caught off guard now that the emergency is officially over.

Federal legislation passed during the pandemic prohibited states from terminating a Medicaid enrollee’s coverage until the end of the public health emergency, which enabled the federal program to grow and contributed to a record-low national uninsured rate.

These provisions have concluded, however, and it’s become apparent that beneficiaries were not made aware of the change. 

In a Kaiser Family Foundation (KFF) poll released this week, two out of three Medicaid enrollees said they were “not sure” if states could remove people from Medicaid for no longer being eligible or not completing the renewal process. Nearly half of the respondents said they had never even been through the renewal process before, which is understandable considering people haven’t had to go through it in three years.

“The KFF data was, I think, alarming, but not particularly surprising given this has been the concern that a lot of policymakers have had throughout this,” Louise Norris, policy analyst for HealthInsurance.org, told The Hill. “We've known for a long time that this is eventually going to happen, especially throughout this part of this year.”

States have been given until May 2024 to complete the “unwinding” process of unenrolling people who are no longer eligible for Medicaid coverage.

An earlier survey from KFF estimated that up to 17 million people could lose coverage with the termination of COVID-19 measures.

Many will lose coverage due to no longer being eligible, but others stand to become uninsured due to “administrative churn,” a term federal agencies use to refer to clerical issues that prevent people from receiving services. These obstacles include changes of address, insufficient contact information or enrollees simply struggling with the renewal process.

Joan Alker, director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said she has observed high rates of “procedural denials” in some states, meaning people were denied coverage due to not completing the renewal process, not because they were ineligible.

“We've seen three states, at least in the first round of data, that their procedural denial rate was over 80 percent: Arkansas, Florida and Indiana,” Alker said. “If a governor sees that high procedural denial rate, in my opinion, they should pause the process and see what's going wrong.”

With many individuals losing coverage regardless of their eligibility, stakeholders want people to know their options going forward. Norris pointed out three viable options for most people who lose coverage during the unwinding period.

• The majority of those who are no longer eligible for Medicaid coverage should be up for an employer health plan. These individuals may qualify for a special enrollment period of 60 days after their Medicaid coverage ends.
  
• Some people aged into Medicare eligibility during the course of the pandemic and have yet to transition to the separate federal health insurance program for seniors. Such individuals have been given six months to transition from Medicaid to Medicare without incurring late enrollment penalties.
  
• People who don’t have access to either Medicaid or employer coverage can also look into getting coverage through HealthCare.gov, with many states offering special enrollment periods as well.

Alker stressed that parents should be aware their children are likely still eligible for coverage under the Children's Health Insurance Program (CHIP). An earlier projection from Georgetown estimated that up to 6.7 million children could lose Medicaid coverage as eligibility is reassessed.

“I think one really important message, from my perspective, is that parents need to know that their children are probably still eligible,” said Alker. “And so they may be on a different path from their children. And over half the children in the country now are insured through Medicaid. This is of enormous consequence for children."

Uninsured rates in the U.S. have reached record lows thanks in part to the temporary measure enacted during the pandemic. Even in an ideal situation with extensive outreach, large numbers of people are expected to lose their coverage, turning back some of the progress that has been made.

The Congressional Budget Office released a report estimating that 15.5 million people will leave Medicaid during the 18-month unwinding period, and 6.2 million of those people will become uninsured.

“Obviously in an ideal world, all these folks who transition off of Medicaid will transition to one of those other categories of coverage, but I think policymakers understand that it's unrealistic to expect that to be universal,” Norris said. “Some folks are going to become uninsured despite policymakers' best efforts. How much it changes, I think, remains to be seen.”