PHE Expiration Will Lead to Medicaid Coverage Losses for 18M People

If the COVID-19 public health emergency (PHE) ends in April 2023, 18 million people may lose Medicaid coverage in the 14 months following its expiration, according to a brief from the Robert Wood Johnson Foundation (RWJF) and Urban Institute.

Congress helped maintain access to Medicaid during the PHE by increasing the federal medical assistance percentage (FMAP) and requiring state Medicaid agencies to keep beneficiaries enrolled in coverage.

HHS renewed the PHE for another 90 days on October 13, 2022, and it is expected to continue until at least April 2023, as the department has not given a 60 days’ notice of its end. States must resume Medicaid eligibility redeterminations and renewals within 14 months after the PHE ends.

Researchers analyzed the latest administrative data from states to project Medicaid enrollment and used the Urban Institute’s Health Insurance Policy Simulation Model to predict coverage impacts after the PHE ends.

The brief estimated that 18 million people will lose Medicaid coverage after the PHE expires, including 10.6 million adults and 7.3 million children. Around 3 million children are projected to transfer to separate CHIP programs, leading Medicaid and CHIP enrollment to decline by 14.8 million people (17.3 percent).

After coverage transitions have occurred, an additional 3.8 million people are projected to be uninsured. Around 40 percent of those people would be eligible for marketplace premium subsidies but may not enroll. Marketplace plans may have higher premiums for less comprehensive coverage, individuals may be unaware of their eligibility, or limited coordination between state Medicaid agencies and marketplaces could create enrollment barriers.

Nongroup coverage is projected to increase by 1 million people. Meanwhile, around 9.5 million people will newly enroll in employer-sponsored coverage after the PHE expires, the brief estimated.

Medicaid enrollment after the PHE will likely vary by state due to unemployment rates. In states with lower employment, more people will maintain Medicaid eligibility. Twenty-nine states and the District of Columbia had a higher unemployment rate in February 2022 than in February 2020, while 19 states had lower unemployment rates in February 2022.

Medicaid and CHIP statewide enrollment reductions could range from 10 to 33 percent, researchers estimated. States with high decreases in Medicaid enrollment will likely see significant increases in the uninsurance rate. Uninsurance is projected to increase by 20 percent or more in 19 states.

Coverage losses may also differ across the country depending on how states respond to the PHE’s ending.

For example, states could choose to resume income eligibility redeterminations sooner before the FMAP increase expires. If states began rapid disenrollment, around 5 million people could lose Medicaid in the first month after redeterminations occur. Meanwhile, gradual disenrollment over 14 months would decrease Medicaid enrollment by 1 million beneficiaries per month.

In addition, nongroup coverage uptake may be higher in the 18 state-based marketplaces than in states without their own marketplaces, the brief noted.

Extending the PHE further than April 2023 may lead to more people losing Medicaid coverage after it expires due to the higher number of redeterminations states would have to process.

If the PHE is extended until July 2023, 19 million people will be disenrolled from Medicaid and 3.3 million children will enroll in separate CHIP programs, leading to a 15.6 million reduction in Medicaid and CHIP enrollment. Additionally, 3.9 million more people would be uninsured, researchers projected.

Separate Urban Institute research revealed that 62 percent of adults who were enrolled in or had a family member enrolled in Medicaid were unaware of the upcoming Medicaid renewals resuming after the PHE ends.

Low awareness and information gaps regarding post-PHE Medicaid policies may contribute to beneficiaries losing coverage, even when they may still be eligible.

Before the PHE ends, state Medicaid agencies should prioritize member outreach and partner with community-based organizations to help guide their communities through future Medicaid coverage changes.