What happens after people lose Medicaid coverage?

Firstly of the pandemic, Congress enacted the Households First Coronavirus Response Act (FFCRA), which included non permanent situation Medicaid packages preserve folks continuously enrolled, and in return, states have obtained enhanced federal funding. Beneath 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 aspects in medical health 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 nicely folks 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 transient for extra particulars. Key findings embrace:

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

Primary findings

Within the 12 months following disenrollment from Medicaid/CHIP, almost two-thirds (65%) of individuals had a interval of uninsured whereas solely 35% have been repeatedly enrolled in protection (Determine 1). The 65% of Medicaid/CHIP enrollees who skilled uninsured post-withdrawal consisted of people that have been: uninsured all 12 months (17%), uninsured for a number of the 12 months and had one other supply of protection throughout the 12 months (16%) and uninsured He had after de-enrolling however ultimately re-enrolled in Medicaid/CHIP (or “churn”) earlier than the top 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: have been enrolled in one other supply of protection for the 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 top of the 12 months (9%). Notably, most individuals who have 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 health insurance.

Practically 4 in ten (41%) individuals who choose out of Medicaid/CHIP will ultimately 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% have been uninsured previous to their Medicaid/CHIP re-enrollment. Claudication happens for a number of causes. These enrolled could face short-term adjustments in revenue that make them quickly ineligible. Disruption can also happen when people who find themselves nonetheless eligible for Medicaid/CHIP lose protection for administrative causes, resembling difficulties finishing annual renewals. In the end, Medicaid/CHIP on and off can prohibit 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 could cause protection disruptions when it requires folks to alter well being care suppliers or cycle by completely 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 throughout 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 throughout the 12 months. This quantity contains the 33% who re-enroll in Medicaid/CHIP after a interval of not being insured, indicating that many individuals have been nonetheless eligible after they misplaced Medicaid/CHIP protection. Even amongst individuals who initially enrolled with different protection, 34% didn’t preserve it for the complete 12 months; These people ultimately misplaced their different protection (and have become uninsured) or re-enrolled in Medicaid/CHIP. General, folks in our evaluation who had overlapping protection (eg, Medicaid/CHIP and particular protection) previous to shedding Medicaid/CHIP have been much less more likely to turn into uninsured or turn into careworn in comparison with those that didn’t have overlapping protection.

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

State Medicaid companies and different stakeholders can take motion a number of steps To cut back protection disturbances and flopping throughout cooldown. Typically, these actions might 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 steering Meant to scale back protection disruptions for Medicaid enrollees/CHIP imposed Reporting necessities To watch the dismantling of states. Though our evaluation offers a pre-pandemic baseline for people’ medical health insurance adjustments after shedding Medicaid/CHIP protection, state jaw insurance policies may have a major impression on whether or not folks will likely be extra profitable in transitioning to different protection after shedding Medicaid than they’d before- Epidemiological traits.

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 an extra 12 months as a result of 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 health insurance outcomes over the research interval.

Examine populations and exceptions

We restricted our evaluation to people who have been disenrolled from Medicaid/CHIP inside 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 not less than 4 consecutive months of Medicaid/CHIP previous to disenrollment to exclude anybody who was enrolled below presumed eligibility or for emergency providers however was then decided to be ineligible. We excluded folks age 65 and older who have been youthful than age 65 with Medicare as a result of Medicare is the first driver of acute care when folks have each Medicare and Medicaid. Lastly, we excluded a small variety of people who have been so exterior the scanning vary Through the research interval (for instance, if somebody dies, strikes in another country, or turns into institutionalized). After these exceptions, the ultimate pattern included 1,160 individuals.

medical health insurance standing

For every month throughout the panel, we generated an index that categorized people as both enrolled in Medicaid; get protection apart from Medicaid; or not insured. For folks 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 dwell in the identical family as the first respondent. Well being protection questions as much as 2018 have 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 individual degree (eg, “Has anybody within the family been lined by…?” Individual 1 lined by…?”). Nevertheless, we anticipate the change to have little impact on how respondents report medical health insurance protection for relations.

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