Medicaid: Millions of vulnerable Americans likely to lose benefits once the Covid federal public health emergency ends

“The main concern I have is people are going to be cut off for reasons that have nothing to do with their eligibility,” said Gordon Bonnyman, a staff attorney for the Tennessee Justice Center, a nonprofit working for affordable health care. “Either they drop the ball, or the state drops the ball.”

The unprecedented work that lies ahead will wind down a profound, temporary change Congress made to Medicaid, the nation’s largest public health insurance program, early in the pandemic.

The first coronavirus relief law, in March 2020, offered states a bargain to help them cope with the sudden spurt of Americans losing jobs and health benefits that accompanied the worst public health crisis in a century: The federal government would give states extra money to help pay for Medicaid if they promised not to move anyone off the program as long as the emergency lasted.

Every state accepted the bargain at a moment when few imagined that, two years later, the pandemic — and the public health emergency the Department of Health and Human Services has been renewing every 90 days since the coronavirus’s first winter — would still be present. In that time, Medicaid caseloads have jumped about 22 percent nationally as new people have joined and no one has cycled on and off the rolls. The nearly 78 million Americans on Medicaid as of September, the latest figure available because federal tallies run months behind, are the most since the program began as a shared federal-state responsibility in the 1960s as a pillar of President Lyndon B. Johnson’s War on Poverty.

Once the federal emergency is lifted, every state will need to reassess its entire bloated roster. Many of the people who will be removed from the safety-net insurance probably will qualify for private health plans, according to Biden administration officials and health-care researchers and advocates.

But large questions hover over how many beneficiaries whose incomes have risen above Medicaid’s eligibility thresholds will simply disappear instead of sliding over to other insurance. And it is unclear how many who remain eligible will be removed from the program improperly.

For Biden health officials, helping states get ready for this enormous task — dubbed “unwinding” from the health emergency — has been a preoccupation for several months. They have sent states a detailed punch list of recommended steps to take in preparation, dispatched letters spelling out federal expectations and continued to confer often with each state.

“This is at the top … of our priority list,” said Daniel Tsai, who oversees Medicaid in HHS’s Centers for Medicare and Medicaid Services. “We intend to and are using all levers available to us to make sure we are connecting people with coverage.”

Still, each state runs its own program. Interviews with state officials, health-care advocates and policy specialists reveal deep differences over how much time, effort and money states are devoting to this work. In certain places, advocates warn that problems — including outdated addresses for renewal notices and error-prone computer systems — could undermine some of the poorest Americans’ ability to afford care. ...