By Lori Lee
NDG Contributing Writer
During the pandemic, 83 million Americans were protected by Medicaid, preserved by a freeze on redetermination checks. This was so no one would lose coverage during the national emergency, explained Katherine Hampstead, senior policy advisor of the Robert Wood Johnson Foundation at a Friday, Aug. 9, 2024 briefing on Medicaid.
In May 2023, when the emergency was halted, Americans began returning to normal bureaucratic routines. This will result in massive coverage losses for about 23 million people, said Hempstead.
And of those who have already been dropped, 69% lost coverage due only to paperwork, she added, while not failing to meet qualifications.
The process of redetermination will worsen coverage gaps for the very populations the program was designed to protect, said Hempstead. Fifty-nine years ago, Medicaid was established to cover senior, disabled, pregnant and low-income citizens, and children.
The Affordable Care Act (ACA) later provided for an expansion of Medicaid to bridge a gap for low-income adults without children. Yet, the Supreme Court blocked the effort, leaving participation up to the states.
In states that did not expand, due to low income limits, two to three million people now have a cruel outcome, said Hempstead, with income so low they do not qualify for help, either through the Health Insurance Marketplace or through Medicaid.
Over time, most states have taken advantage of the opportunity to expand Medicaid under the ACA, Illinois and a few on the west coast expanding coverage regardless of immigration status.
Yet, ten states, mainly in the south, chose not to expand, this including Texas, which also leads the way in the number of children falling off eligibility rolls.
The gap weighs heavily on people of color, especially those living within the non-expansion states, she added.
Their organization believes healthcare is a right, said Hempstead, meaning closing these gaps and making healthcare affordable for everyone is a high priority.
They researched the economic benefits to communities in expansion states and found there were lower numbers of bankruptcies and increased labor productivity, she noted.
Martha Sanchez, Health Policy and Advocacy Director at Young Invincibles also spoke at the briefing. “Despite our name, young people are not invincible,” said Sanchez.
Assuming they’re at lower risk, or simply holding onto the mentality it won’t happen to them, about 30% of adults 18-34 are uninsured, higher than any other group.
Yet, the American Cancer Society reports, young adults are increasingly more susceptible to serious conditions, like colon cancer, a 2019 study indicating at least half of young adults have at least one chronic condition.
Unaware of their risks and sometimes lacking the enrollment know-how, Sanchez said literacy is key. We want to get the Department of Education involved, she said. Many children dropped from Medicaid would still qualify if they could just learn the process.
Executive Director and Co-Founder of the Center for Children and Families, Joan Alker, also spoke. Alker is a research professor at Georgetown University. She said that since the pandemic, one third of all young adults report symptoms of mental illness, often without the health coverage to get help. They’re having to skip medications, go without inhalers, and miss behavioral health treatments, she said.
Stan Dorn, director of the Health Policy Project at UnidosUS, suggests that using accessible assistance and paperless eligibility could help bridge the gaps. Automatic renewal could utilize tax and wage information that the government already possesses.
And federal performance standards for redetermination could incentivize states, providing bonuses to states that exceed standards, and deferring federal payments until states make improvements.
As it stands, “a family has a very different likelihood of getting health care based simply on the state in which they happen to live.”
