15M Beneficiaries Will Lose Medicaid Coverage When PHE Ends

Around 15 million beneficiaries will lose Medicaid coverage when the program’s continuous enrollment provision ends with the COVID-19 public health emergency (PHE), according to a report from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE).

The Families First Coronavirus Response Act (FFCRA) required Medicaid and the Children’s Health Insurance Program (CHIP) to maintain enrollment for beneficiaries throughout the PHE and paused the program’s renewal and redetermination process.

After the PHE ends, states will have 12 months to begin redetermining Medicaid and CHIP eligibility for beneficiaries.

To determine how many Medicaid beneficiaries will lose coverage due to the PHE ending, researchers used 2021 enrollment data and data from the Survey for Income and Program Participation (SIPP) from March 2015 to November 2016. The 21-month period was treated as comparable to a PHE period lasting from March 2020 to December 2021.

Around 86.7 million people were enrolled in Medicaid in December 2021.

Almost 18 percent of Medicaid and CHIP beneficiaries, or 15 million, are predicted to lose Medicaid coverage once the PHE ends. Of these 15 million, 8.2 million are expected to lose coverage due to ineligibility, while 6.8 million will still be eligible but lose coverage due to administrative churning.

The coverage losses will disproportionately impact certain populations. For example, children up to age 17 account for 17.1 percent of beneficiaries expected to be ineligible for Medicaid and 57.1 percent of the eligible population that will lose coverage.

Young adults between 18 and 34 make up 38 percent of those estimated to lose eligibility and 23 percent of those that will lose coverage due to administrative churning.

The report also examined race and economic data when determining who will lose coverage.

Latino individuals comprised over 25 percent of people that will be ineligible for Medicaid coverage and 35 percent of those who will experience churning.

Black individuals accounted for 14 percent of people expected to lose eligibility and 15 percent of beneficiaries predicted to experience churning.

Beneficiaries with incomes between 138 and 250 percent of the federal poverty level account for nearly 40 percent of those who will lose Medicaid eligibility. People with incomes less than 100 percent of the federal poverty level make up 55 percent of those predicted to lose coverage due to administrative churning.

Alternative coverage options are available for most beneficiaries who are expected to lose eligibility for Medicaid or CHIP. Over 3.5 million are estimated to enroll in employer-sponsored health insurance.

Nearly 2.7 million beneficiaries will be eligible for Marketplace premium tax credits. Among these beneficiaries, 1.7 million may be eligible for zero-premium Marketplace plans under the American Rescue Plan Act (ARPA).

However, 383,000 individuals who are predicted to be ineligible for Medicaid will fall into a coverage gap, the report found. These individuals will likely reside in one of the 12 states that have yet to expand Medicaid coverage and have incomes too high for Medicaid but too low to receive Marketplace premium tax credits.

Expanding Medicaid in the 12 remaining states could help mitigate coverage losses once the PHE ends, researchers said.

The Inflation Reduction Act of 2022 will also help expand coverage for those losing Medicaid eligibility. The regulation extended the ARPA premium tax credits until 2025.

In addition, HHS is working with states to facilitate enrollment in alternative healthcare coverage and reduce administrative churning, the report concluded.