Medicaid Expansion Could Prevent Coverage Loss During Redeterminations

Total Medicaid expansion could prevent massive coverage losses in nonexpansion states as Medicaid redeterminations restart, an issue brief from the Kaiser Family Foundation found.

The researchers used data from the 2021 American Community Survey (ACS). They used methods from the State Health Access Data Assistance Center (SHADAC) and Pew Research Center data to make estimates about the community of immigrants who are not lawfully present. They also used the Current Population Survey (CPS) to design some of their models.

“Expansion could help stem increases in the number of people who are uninsured as the Medicaid continuous enrollment provision ends and states resume disenrollments after a three year pause during the pandemic,” the researchers suggested.

“When the continuous enrollment provision expires on March 31, 2023 and states resume regular Medicaid disenrollments, millions are expected to lose Medicaid if they are no longer eligible or if they face barriers completing their renewals. While most people who are determined to no longer be eligible in expansion states will qualify for other coverage, either through the Marketplace or through an employer, in non-expansion states, poor parents who are no longer eligible for Medicaid will likely fall into the coverage gap and become uninsured.”

Around 1.9 million individuals fall into a coverage gap in the states that have not expanded Medicaid—their incomes are below the federal poverty level but they are ineligible for Medicaid coverage.

States without Medicaid expansion have uninsured rates of 15.4 percent, while states that have adopted Medicaid expansion have rates closer to 8.1 percent or nearly half the rate of nonexpansion states.

Childless adults with low incomes are especially prone to uninsurance in these states because all except for Wisconsin lack a pathway to coverage for this population. Ninety-seven percent of people in the coverage gap live in the South and a fifth live in Florida. Over 60 percent of the individuals who fall into the coverage gap are people of color, a significantly disproportionate share.

Lack of a work ethic is not the primary barrier to coverage for those who fall into the coverage gap: 43 percent of individuals in the coverage gap are working and 58 percent are in a family with a worker. Common jobs include being a cashier, waiter or waitress, or a house cleaner.

The problem is that employers who hire low wage workers often do not offer employer-based insurance or these insurance options are not affordable. Additionally, part-time work can disqualify parents from Medicaid coverage in non-expansion states.

Around 3.5 million individuals—including the 1.9 million in the coverage gap—could gain healthcare coverage if the remaining nonexpansion states adopted Medicaid expansion. Plus, individuals who are eligible for Marketplace coverage but not currently enrolled would also become eligible for Medicaid coverage.

Medicaid expansion has been associated with improvements in coverage, health equity, access to care, patient outcomes, and economic factors. Residents in states that have adopted Medicaid expansion have gained better access to behavioral healthcare, reproductive care, and chronic disease prevention and management services.

The ballot process has been crucial to the successful expansion of Medicaid in many states. However, in the ten states that have not expanded Medicaid, ballot initiatives for adopting Medicaid expansion are not an option.

With the public health emergency coming to a close and Medicaid redetermination processes underway, experts estimate that as many as 18 million individuals could lose Medicaid coverage. States have been preparing for the Medicaid redetermination process for months, but, for many beneficiaries, their Medicaid eligibility is still unknown.