The dismantling of one of the last major Covid-era safety nets is resulting in millions of people being removed from state Medicaid rolls. Congressional Democrats and health advocates are urging the Biden administration to take stronger action to protect these individuals.
According to the health policy research group KFF, nearly 5.5 million people have been purged from state Medicaid rolls across 45 states and the District of Columbia. It is estimated that at least 1 million of those affected are children, though the actual number is likely higher due to incomplete reporting by some states.
Most individuals have been removed from Medicaid for procedural reasons, such as missing or incorrect paperwork, or outdated contact information. However, many may still be eligible for the program.
Last year, Congress granted the Centers for Medicare and Medicaid Services (CMS) more authority to prevent improper removal of Medicaid beneficiaries by states. The agency can now require states to halt procedural terminations, develop corrective action plans, or even withhold federal funding.
Joan Alker, executive director of Georgetown University’s Center for Children and Families, stated that swift and decisive action from the Biden administration is necessary, particularly when a significant number of children are losing coverage due to procedural terminations.
Democrats in Congress have been calling on the administration to take more aggressive measures against states that fail to address high rates of procedural terminations. Concerns were first raised when states began reporting data in June.
Senate Finance Committee Chairman Ron Wyden (D-Ore.) and House Energy and Commerce Committee ranking member Frank Pallone Jr. (D-N.J.) previously urged CMS to threaten to withhold funding from state Medicaid programs if they did not make good-faith efforts to prevent procedural terminations.
The entire Texas Democratic delegation, led by Rep. Lloyd Doggett, sent a letter to CMS in August, requesting swift intervention to prevent the loss of coverage in Texas, which already has the highest number of uninsured people in the country. Over the past four months, Texas reported that more than 600,000 residents had their health coverage terminated, including nearly half a million children.
Texas is considered an outlier in terms of Medicaid enrollment due to its large program size and lack of Medicaid expansion. The majority of enrollees in Texas are children, and the high percentage of children affected by the terminations raises concerns.
In addition, whistleblowers in the Texas Department of Health and Human Services identified nearly 100,000 individuals who had their health coverage erroneously terminated.
The Texas Democratic delegation and other advocates have expressed doubts about the state’s ability to protect its residents. They are urging CMS to intervene and pause the process before the next round of redetermination begins in September.
CMS has been expressing concerns for months about states rushing through the Medicaid reassessment process, but its actions have been relatively restrained. The agency has required 14 states to pause Medicaid disenrollments, but it has not disclosed which states specifically.
Recently, CMS sent letters to state health officials in all 50 states and D.C., publicly notifying them of its oversight and enforcement priorities. The letters addressed concerns about high rates of procedural terminations, long call center wait times, call abandonment rates, and slow application processing.
Although much of the focus has been on Republican-led states, the letters cited a total of 36 states, including blue states, for at least one problem.
While these efforts from CMS are seen as a step in the right direction, there are concerns about the extent of coverage losses. The lack of transparency regarding CMS’s actions makes it difficult to determine their effectiveness.
CMS assures that it takes its role in monitoring and overseeing Medicaid renewals seriously and is committed to helping states exceed minimum requirements to maintain coverage. The agency emphasizes that it will hold states accountable for failing to meet federal requirements.
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