What happens after people lose Medicaid coverage?

Initially of the pandemic, Congress enacted the Households First Coronavirus Response Act (FFCRA), which included non permanent situation Medicaid applications preserve folks consistently enrolled, and in return, states have obtained enhanced federal funding. Below the continual recording clause, Medicaid enrollment It has grown exponentially in comparison with what it was earlier than the pandemic and the patriotism Uninsured charge had refused. provisions contained in Consolidated Appropriations Act (CAA). To retract current features in medical insurance protection.

The important thing query is whether or not individuals who lose Medicaid will have the ability to 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 temporary for extra particulars. Key findings embody:

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

Principal findings

Within the yr following disenrollment from Medicaid/CHIP, practically two-thirds (65%) of individuals had a interval of uninsured whereas solely 35% had been repeatedly enrolled in protection (Determine 1). The 65% of Medicaid/CHIP enrollees who skilled uninsured post-withdrawal consisted of people that had been: uninsured all yr (17%), uninsured for a few of the yr and had one other supply of protection through the yr (16%) and uninsured He had after de-enrolling however finally re-enrolled in Medicaid/CHIP (or “churn”) earlier than the tip of the yr (33%). The 35% of Medicaid/CHIP enrollees who maintained protection for a full yr after de-enrollment in Medicaid/CHIP consisted of people that: had been enrolled in one other supply of protection for the whole yr (26%) and had one other supply of protection for a few of the yr but additionally re-enrolled in Medicaid/CHIP earlier than the tip of the yr (9%). Notably, most individuals who had been coated for the complete yr after deenrollment had an overlapping interval of protection earlier than they misplaced Medicaid/CHIP throughout that point they’d each Medicaid/CHIP and personal medical insurance.

Almost 4 in ten (41%) individuals who decide out of Medicaid/CHIP will finally go on to re-enroll in Medicaid/CHIP inside a yr (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% had been uninsured previous to their Medicaid/CHIP re-enrollment. Claudication happens for a number of causes. These enrolled could face short-term adjustments in earnings that make them quickly ineligible. Disruption may additionally happen when people who find themselves nonetheless eligible for Medicaid/CHIP lose protection for administrative causes, corresponding to difficulties finishing annual renewals. In the end, Medicaid/CHIP on and off can limit 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 vary well being care suppliers or cycle by completely different profit packages.


These findings spotlight that many individuals don’t switch to and preserve different protection after opting out of Medicaid/CHIP. Total, 65% of individuals had a protection hole through the yr after de-enrolling in Medicaid/CHIP and solely 26% of individuals enrolled and saved one other supply of protection for a full yr after shedding Medicaid/CHIP protection. Of people that disenroll from Medicaid/CHIP, 41% re-enrolled through the yr. This quantity contains the 33% who re-enroll in Medicaid/CHIP after a interval of not being insured, indicating that many individuals had 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 whole yr; These people finally misplaced their different protection (and have become uninsured) or re-enrolled in Medicaid/CHIP. Total, folks in our evaluation who had overlapping protection (eg, Medicaid/CHIP and particular protection) previous to shedding Medicaid/CHIP had been much less more likely to change into uninsured or change into confused 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 yr. 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 change into uninsured if they don’t switch to different protection. Others will lose protection for administrative causes although they’re nonetheless eligible. Whereas the tens of millions of people that misplaced protection through the leisure course of would face related challenges to these included on this evaluation, there are additionally vital variations at this time. For instance, Congress they expanded ACA market-enhancing subsidies, which had been first included within the American Rescue Plan Act (ARPA) through the pandemic, making these plans extra inexpensive 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 non-public insurance coverage than they had been earlier than the pandemic, which reduces protection disruptions for these people after they decide out of Medicaid. Nonetheless, that is solely a subset of the individuals who will likely be deregistered through the dismantling course of. Most people who will lose out on Medicaid whereas disengaged as a result of they not qualify will nonetheless have to switch to (and preserve) different medical insurance to keep away from a protection hole.

State Medicaid businesses and different stakeholders can take motion a number of steps To scale back protection disturbances and flopping throughout cooldown. Usually, these actions might embody bettering state eligibility programs, 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 Supposed to scale back protection disruptions for Medicaid enrollees/CHIP imposed Reporting necessities To observe the dismantling of states. Though our evaluation offers a pre-pandemic baseline for people’ medical insurance adjustments after shedding Medicaid/CHIP protection, state jaw insurance policies can have a major impression on whether or not folks will likely be extra profitable in transitioning to different protection after shedding Medicaid than they might 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 yr 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 insurance outcomes over the research interval.

Examine populations and exceptions

We restricted our evaluation to people who had been disenrolled from Medicaid/CHIP throughout 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 a minimum of 4 consecutive months of Medicaid/CHIP previous to disenrollment to exclude anybody who was enrolled underneath presumed eligibility or for emergency companies however was then decided to be ineligible. We excluded folks age 65 and older who had 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 had been so exterior the scanning vary In the course of 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 members.

medical insurance standing

For every month through 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 had been requested on the family degree (eg, “Has anybody within the family been coated by…?”), however the questionnaire has been up to date to ask these questions on the individual degree (eg, “Has anybody within the family been coated by…?” Individual 1 coated by…?”). Nonetheless, we count on the change to have little impact on how respondents report medical insurance protection for members of the family.

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