50% of MN Adults Were Uninsured Following Medicaid Disenrollment

Half of adults who experienced Medicaid disenrollment in Minnesota were uninsured six months after losing coverage, raising concerns about eligibility redeterminations that recently resumed.

The study, published in JAMA Network Open, used monthly enrollment records from the Minnesota All Payer Claims Database (MN APCD) for residents aged 64 or younger who were disenrolled from Medicaid between January 1, 2018, and February 28, 2019.

Researchers noted individuals’ coverage status and type six and 12 months after Medicaid disenrollment. Individuals were considered lost to follow-up if they were never observed as having coverage between disenrollment and September 2021, the last month of available data.

The study sample included 346,734 Medicaid disenrollments. Almost 60 percent of cases (204,345) were matched to an enrollment record between Medicaid termination and September 2021, while 142,389 were considered lost to follow-up. These individuals may have been uninsured or enrolled in non-reporting plans, researchers noted.

Among cases that were not lost to follow-up, there were 140,420 adults and 63,524 children. Six months after Medicaid disenrollment, 17.6 percent of children had enrolled in commercial group coverage and 2.2 percent had enrolled in individual coverage.

Almost half of the children (48.7 percent) did not have identifiable coverage at six months. This figure dropped to 29.8 percent after 12 months, primarily due to re-enrollment in Medicaid. After disenrolling from Medicaid, 51.2 percent of children re-enrolled one year later, the study found.

Among adults, 50.1 percent did not have identifiable coverage six months after being disenrolled from Medicaid. The share fell to 39.1 percent at 12 months. Nearly 14 percent of adults had commercial group coverage and 5.9 percent had individual coverage 12 months after losing Medicaid. Around one-third (32.8 percent) of adults re-enrolled in Medicaid a year later.

Researchers noted that a significant share of disenrollment may have been among individuals who were eligible for Medicaid or experienced short-term changes in eligibility that did not last for a full year. These transitions can disrupt access to care for people and incur administrative costs for states.

The COVID-19 public health emergency is set to end on May 11, and the Medicaid continuous enrollment policy ended on March 31. States began resuming Medicaid redeterminations on April 1.

HHS has projected that 15 million beneficiaries will lose Medicaid coverage once the redetermination process is complete. Around 8 million are expected to lose coverage due to ineligibility and 6.8 million will lose coverage due to administrative churning.

A study from NORC at the University of Chicago funded by AHIP found that beneficiaries who are disenrolled from Medicaid will likely transition to employer-sponsored health plans in most states. Meanwhile, 21 percent are projected to become uninsured, 15 percent will enroll in CHIP, 7 percent will join non-group coverage, and 3 percent will enroll in other public payer coverage.