• About 17% of enrollees in Medicaid and the Children’s Health Insurance Program, or 15 million people, could lose their coverage when states resume regular eligibility checks once the COVID-19 public health emergency ends, HHS projected in a report from the Office of the Assistant Secretary for Planning and Evaluation. 
  • Loss of eligibility will require 9.5% of beneficiaries to transition to another source of health insurance, while nearly 8% will leave the program despite remaining eligible due to difficulty navigating the renewal process and other administrative issues, HHS reported.
  • The agency said it is taking steps to reduce the risk of people becoming uninsured at the end of the public health emergency, including working with state and federal marketplaces to facilitate enrollment in other coverage options and stepping up outreach and education efforts. About 5.3 million children and 4.7 million young adults ages 18 to 34 are predicted to lose coverage. Of those, nearly a third are Latino and 15% are Black.

Dive Insight:

Health policy experts have been sounding the alarm about potential coverage losses for millions of Americans, including children, when pandemic protections expire. The nation’s uninsured rate fell to a historic low of 8% in the first quarter of this year, due in large part to the suspension of Medicaid coverage terminations that has swelled the number of participants in the program.

To help mitigate the disruption, the CMS issued guidance to assist states in November 2021 for transitioning those who will lose Medicaid and CHIP eligibility to other health insurance, such as subsidized plans, through Affordable Care Act marketplaces.

The extension of premium subsidies in the new Inflation Reduction Act is expected to improve access to alternative coverage for some losing Medicaid eligibility at the end of the public health emergency. The legislation extends enhanced marketplace subsidies until 2025.

Of those predicted to lose Medicaid and CHIP eligibility, 2.7 million people are expected to qualify for marketplace premium tax credits, the ASPE report said. Among this group, more than 60% are expected to qualify for zero-premium marketplace plans under the provisions of the American Rescue Plan. Another 5 million people are expected to obtain employer-sponsored insurance.

An estimated 383,000 people projected to lose Medicaid eligibility would fall in a coverage gap in the 12 non-expansion states because they have incomes too high for Medicaid but too low for marketplace tax credits.

Coverage losses due to administrative hurdles are also a high risk due to the volume of redeterminations that states must conduct and the length of time since Medicaid agencies last communicated with many beneficiaries, ASPE warned. The CMS is coordinating efforts with state Medicaid and CHIP agencies to minimize coverage lapses, the report added.