A Vast Nationwide Purge Is Cutting Millions Off Health Care

More than 10 million Americans have been booted off Medicaid since April. A new study finds that number could triple if the Biden administration does not act. Most have been cut on a technicality.

By Jordan Zakarin, More Perfect Union

Tiffany Givens found out from a phone call from her therapist’s office. She had an appointment scheduled for the next day, but the therapist who had been helping her through some family trauma would have to cancel if Tiffany couldn’t sort out her health insurance, which had been deactivated.

Tiffany had been enrolled in Medicaid for the past several years, and as far as she knew, nothing had changed. Panicked, she began rifling through her records. As a single mother of four, she didn’t always have time to be thorough.

“I went through all any notices that were available to me and I saw nothing posted,” she recalled in a conversation with More Perfect Union earlier this fall. “And I never got anything in the mail saying anything about why I was considered a non-qualifying adult or why [my insurance] should be inactive.”

A few weeks after learning that she’d lost her health care, Givens found out that she was pregnant. Her eligibility assured, she re-applied for Medicaid, only to receive a letter with an appointment date that had already passed. Another application sat untouched for months.

Tiffany is one of 325,000 Georgians and 10 million Americans, including two million children, who have been kicked off of Medicaid since April when a federal moratorium on disenrollment was lifted. The date, stipulated in the debt ceiling deal struck last December, marked the end of the national COVID-19 health emergency, which in turn meant the expiration of the final remaining pandemic-era safety net programs. 

One of those programs, outlined in the Families First Coronavirus Response Act passed in March 2020, provided states extra funding for scores of people who lost their jobs and enrolled in Medicaid. In exchange, states could not remove beneficiaries based on their income. 

Medicaid rolls swelled by more than 20 million people during what became a three-year moratorium, and when it ended, the federal government issued detailed guidance on how to ensure that beneficiaries knew that they would once again have to prove their eligibility.

Many states, however, patently disregarded that guidance and raced to purge as many people as possible from the low-income health program. Thus far, more than 70 percent of those cut from the Medicaid rolls were removed not because their income had increased, but because they experienced some kind of technical problem known as a procedural denial. 

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Technically, that means that they didn’t respond to warnings from the state. But advocates say that between state governments sending mail to the wrong address, limiting their call center hours to the point of inaccessibility, and refusing to fix glitch-filled apps, most people either had no idea that their health care was at risk or were unable to prevent an unwarranted removal.

The suffering has been especially stark in the dozen Republican-controlled states that have not expanded Medicaid, like Texas and Arkansas. In Arkansas, Republicans passed a law last year that required the state to rush through disenrollments within six months, half the time recommended by the federal government. The state purged over 427,000 beneficiaries while renewing 298,000. 

“We're finding that nationally, and it's certainly true in Texas, that a whole lot of folks are getting kicked out even though they might still be eligible because they never had their eligibility checked,” says Stacey Pogue, a policy analyst with the non-profit group Every Texan. “And that means a lot of people who remain eligible are gonna have to try to come back into the program over time.”

With six months left to go, Texas has already removed 1.2 million people from the program, while renewing just 668,000. Of those removed, 65 percent were blindsided with procedural denials, and because so much of the state’s program consists of children, the damage has been particularly pronounced. 

The indiscriminate purges are a policy choice, driven in part by state lawmakers’ adamant refusal to take advantage of assistance being offered by the federal government. Pogue points out that states should be able to determine eligibility without contacting beneficiaries using data from other departments.  

“In Texas, our Medicaid agency gets the Texas Workforce Commission’s quarterly wage data. They know what you earn through other reporting mechanisms,” she says. “And so if they can see that you still earn below X amount and you're still eligible, they can skip sending out the paperwork altogether.”

That process, known as an “ex parte” renewal, has been hobbled by the state’s Medicaid administrators, to the point that only 3 percent of renewals were made via existing data.

The federal government has taken some steps to stop the most indiscriminate purges. In August, the Center for Medicare and Medicaid told 30 states to pause disenrollments in order to restore health care access to about 500,000 people who had been removed due to a mass glitch in the system. 

“The state is responsible for administration,” notes Stacey Abrams, the former Georgia gubernatorial candidate and House Minority Leader. “The state is responsible for communication, and therefore the states are responsible for the failure that's forcing millions of Americans out of access and denying them the coverage they deserve.”

Advocates in Texas and other states are now calling on the federal government to force another pause so that administrators can go through the countless applications and appeals that have been piling up for months without being touched.

The Associated Press reported Wednesday that health consulting firm Avalere projects that up to 30 million Americans could eventually be purged from Medicaid coverage, “many the result of error-ridden state reviews that poverty experts say the Biden administration is not doing enough to stop.”

Democrats in Congress gave Health and Human Services Secretary Xavier Becerra “the power to fine states or halt disenrollments if people were improperly being removed,” the AP noted. But “HHS has shared little about problems it has uncovered. Earlier this year, the agency briefly paused disenrollments in 14 states, but it did not disclose which states were paused or for what reasons.”