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The Wrong Way to Do Medicaid: Enrollment Disparity

Analysis  |  By Marie DeFreitas  
   April 15, 2024

Medicaid unwinding left millions uninsured, particularly children, Black, Hispanic and lower income communities.

Roughly one quarter of Americans who were disenrolled from their pre-pandemic Medicaid coverage are now completely uninsured. Why? High costs and other procedural hurdles that particularly affect minorities and lower income communities who rely heavily on federally funded coverage. Plainly, health coverage is too expensive and trying to prove eligibility can sometimes feel like a fool’s errand.

The provision that kept states from disenrolling consumers from Medicaid during the COVID-19 pandemic ended in March 2023. The Biden administration projected about 15 million people would lose their coverage, but 20 million did instead, according to a Kaiser Family Foundation report. Most states will have until June to continue conducting eligibility reviews, and that 20 million is expected to grow.

The Fight for Coverage

The biggest hurdle for acquiring coverage for more than half (54%) of uninsured adults is simply cost. KFF’s survey looked at over 1,200 adults in February and March 2024, including individuals who stated they had Medicaid coverage in early 2023, prior to the ending of pandemic eligibility rules in April 2023.

Two-thirds (64%) of individuals who were enrolled in Medicaid before the unwinding process began say they took action in 2023 to renew their coverage. The survey found that about one-fifth of all individuals who had Medicaid coverage in early 2023 were disenrolled sometime later that year. Over one-third who attempted to regain any type of coverage said the process was difficult, and about half (48%) called it stressful.

Long call center wait times, excessive paperwork and uncertainty about what paperwork was needed were common complaints. Some states that have not expanded Medicaid require proof of residency in order to renew coverage, creating yet another hurdle. The survey shows that individuals living in non-expansion states were at least twenty percentage points more likely to say they were asked to submit proof of residency. If the state is unable to obtain eligibility documents electronically, then they may put the task back on the enrollee to submit these documents. 

Additionally, Black and Hispanic groups were much more likely than White groups to say they were asked to submit proof of residency to regain coverage: Black groups (71%), Hispanic groups (60%), and White groups (42%).

A recent KFF tracking poll also found that seven out of ten of the overall public (69%) said they heard only “a little” or “nothing at all” surrounding state removals of enrollees from Medicaid as pandemic provisions came to an end.

The survey showed that groups with lower levels of education, particularly those with a high school diploma or less, were far more likely to say they heard “nothing at all” about states removing enrollees from Medicaid.

Apart from administration processing issues and procedural hurdles on Medicaid’s end, among those who took action to renew their coverage, about 14% said they did not have reliable internet access to complete the forms online.

The survey also shows the clear and immediate impact of loss of coverage on health: over half (56%) of individuals surveyed said they missed a necessary healthcare appointment or skipped their prescriptions as they waited to regain coverage.

Who’s Most Affected?

Medicaid enrollment jumped by almost one-third during the pandemic, from 71 million in February 2020 to 94 million in April 2023. But this data isn’t complete, as it doesn’t reflect one of the largest groups affected by Medicaid coverage loss: children.

Children have the highest official poverty rates of any age group. In 2022 about 16% of children aged 0-18 were living in poverty, according to a KFF news report. Furthermore, the report states that in 2022 supplemental poverty rates were the highest for asian children (25.9%), hispanic children (19.5%), and black children (17.8%).

KFF news released a report on April 15 that showed in Texas two million consumers were disenrolled from Medicaid in March 2024, and 1.34 million of those individuals were, you guessed it, children.

The Fix

Overall, those still on Medicaid rate the program positively across all groups. The survey shows that ratings are also consistently positive in both expansion and non-expansion states. Individuals are happy with Medicaid coverage, all things considered. The issue is in acquisition.

As of now, roughly 30 million individuals are still awaiting Medicaid renewals.

Is there room for payers to intervene here? With millions losing coverage, is there any opportunity for payers to put forth new plans or aid in offering affordable supplemental coverage that targets these groups? Maybe, but not without federal allyship, and not without reexamination of this important federally funded coverage, and the procedural barriers that accommodate it.

Marie DeFreitas is an associate content specialist at HealthLeaders.


Medicaid unwinding has left millions insured, and has brought many procedural hurdles for those trying to regain coverage

Minority and low income groups are disproportionately affected when it comes to proving eligibility

Those enrolled in Medicaid rate the program positively

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