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U.S. states will begin stripping up to 15 million people of Medicaid coverage on Saturday as an emergency safety net put in place during the Covid-19 pandemic begins to come to an end.
Medicaid is the government health insurance program for people on low incomes. It is administered jointly by the federal and state governments.
Congress generally prohibited states from ending Medicaid coverage during the pandemic through the Families First Coronavirus Response Act. Passed in March 2020, the law provided people with a safety net as the first deadly wave of Covid swept across the nation and lockdowns crippled the US economy.
Medicaid health coverage grew to more than 85 million people in December, a 25% increase from February 2020, before requirements to keep people enrolled in the program went into effect, according to Department of Health and Human Services data.
However, states can begin throwing people out of Medicaid on Saturday if they no longer meet the program’s pre-pandemic eligibility requirements, which are primarily based on income. Congress in December inserted a provision into federal spending legislation that would allow states to begin deregistering people on April 1.
Although some states begin ending coverage in April, others are waiting until May, June, July and October before doing so. A list of when all 50 states will begin ending coverage is below.
Click here for a list of when states will end the first round of Medicaid coverage. The table was provided by the Kaiser Family Foundation.
States have up to a year to determine whether individuals are still eligible for Medicaid and 14 months to complete the process of renewing their coverage or terminating it, per HHS guidance documents.
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HHS estimates that up to 15 million people will lose insurance coverage if the program returns to pre-pandemic eligibility requirements. Many of these people are expected entitled to other forms of health insurance.
According to HHS, the changes will disproportionately affect people of color and young people. Approximately 30% of those at risk of losing Medicaid coverage are Hispanic and 15% are Black. At the same time, more than 5 million children and 4.7 million adults aged 18 to 34 are allowed be kicked out of Medicaid, according to HHS.
An estimated 2.7 million people who could lose Medicaid coverage should qualify for tax credits under the Obamacare health insurance markets. About 62% of these individuals are expected to be eligible for non-award plans. An additional 5 million people are expected to be able to obtain other forms of coverage, mainly through their employer.
HHS has created a special enrollment period on healthcare.gov to help people transition to Obamacare marketplace insurance if they lose Medicaid between March 31, 2023 and July 31, 2024.
A majority of states, 33 in all, use healthcare.gov as their marketplace for insurance. The 17 states that manage their own marketplaces can, but do not have to, offer this special registration period.
As many as 6.8 million people could lose Medicaid even though they still are eligible for the program. Before the pandemic, people often lost insurance coverage due to bureaucracy. A person could lose coverage if they did not complete the annual renewal process or if their state was unable to reach them due to a change of address or other issues.
Under a A provision passed by Congress in December requires states to make good faith efforts to contact persons whose eligibility is being checked using more than one method of communication. In other words, a state cannot cancel someone’s insurance simply because a mail contact has been returned as undeliverable, which is often due to a change of address or other reason.
HHS estimated in August 2022 that about 383,000 people who lose Medicaid when the spread of the pandemic slows will fall through a bureaucratic crack called the “coverage gap.”
This gap exists in 10 states that have not expanded Medicaid to individuals whose income is up to 138% above the federal poverty line. As a result, some people in these states who are struggling to make ends meet still do not qualify for Medicaid because the income eligibility requirements are so low. Some of these individuals also do not qualify for Obamacare tax credits, leaving them without affordable health insurance options.
Texas and Florida are the two most populous states that have yet to expand Medicaid.