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Published: Apr 18, 2023 12 min read
Caduceus falling over map of the united states
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Millions of Americans will lose their health coverage through Medicaid in the coming months after pandemic-era protections expired — an upheaval that experts say has no precedent.

For the past three years, states have been barred from kicking people off Medicaid in exchange for more funding from the federal government. This provision, tucked into the first COVID-19 aid package, led to a boom in Medicaid rolls over the course of the pandemic.

The expansive government health insurance program for low-income people has ballooned to cover more than 85 million Americans — an increase of about 21 million enrollees from when the continuous-coverage protection first went into effect. Those protections expired at the end of March, and already some states have begun to remove people who no longer qualify for Medicaid.

“This is a big deal,” says Joan Alker, executive director at Georgetown University’s Center for Children and Families. “We expect a change of historic proportions to happen in the next year or so.”

As officials like to say, Medicaid is now “unwinding.” In less euphemistic terms: 15 million Americans, who are disproportionately Black or Hispanic, will lose their health coverage, according to the U.S. Department of Health and Human Services. Independently, the nonprofit Urban Institute found that as many as 18 million people could be disenrolled.

Many of these folks simply don’t meet Medicaid’s stringent income requirements anymore, explains Thomas Waldrop, a health care policy fellow at The Century Foundation. Earlier in the pandemic, many people's incomes took a temporary hit that initially qualified them for Medicaid. As their incomes rebounded, they would have normally been booted off. But the continuous-enrollment rule allowed them to keep their benefits. With that rule gone, this group will certainly lose their coverage.

What really worries experts, though, is how many qualified beneficiaries may fall through the cracks due to reintroduced administrative hurdles.

“If there’s no affirmation of eligibility,” Waldrop says, “the state might disenroll someone as a result, even if they are actually eligible.”

That puts any of the 85 million Americans receiving Medicaid at risk of losing coverage. As eligibility checks restart, the burden of jargon-filled paperwork is expected to particularly disadvantage Latino beneficiaries and other people of color who may not speak English as a first language. For people who enrolled during the pandemic and have never done an eligibility check, the process could be especially confusing.

"The letter might require a law degree to understand what it actually means," Alker says.

How states are purging their Medicaid rolls