Black Americans and Hispanics twice as white Americans to lose Medicaid last year because of the inability to complete the renewal form during the vast trimming of the program is rolling, according to a study published in the journal JAMA Internal Medicine.
The findings from researchers at Oregon Health & Science University, Harvard Medical School and Northwestern University are some of the first comprehensive data on race collected after a pandemic-era policy that allowed Medicaid recipients to maintain coverage without routine eligibility checks ended last year.
More than 22 million low-income people have lost health care coverage since April 2023, when the policy that allows continuous enrollment continues. The process of ending the policy — which federal and state officials call “unwinding” — is one of the most drastic ruptures in the health safety net in a generation.
“Medicaid eligibility is complicated, and then applying for and maintaining Medicaid coverage is a huge logistical hurdle,” said Dr. Jane M. Zhu, a professor of medicine at Oregon Health & Science University and one of the study’s authors. “What this analysis shows is that these barriers have spillover effects in certain communities.”
The researchers found that the increase in health insurance among racial and ethnic groups from 2019 to 2022 was driven by Medicaid.
A provision in the coronavirus aid package passed by Congress in 2020 requires states to keep recipients of federal-state health insurance programs for the poor continuously enrolled in exchange for additional federal funds.
By the beginning of 2023, more than 90 million people will be enrolled in Medicaid and the Children’s Health Insurance Program, or more than one in four Americans. This is up from around 70 million people at the start of the coronavirus pandemic. About half of Medicaid enrollees are black or Hispanic, and about 40 percent are white.
As of May, Medicaid enrollment had declined by more than 13 million, including more than five million children, according to the Georgetown University Center for Children and Families.
Many people who lose coverage have incomes that are too high to be eligible for Medicaid or have aged out of the program. But about 70 percent of people who lose coverage may be eligible and fall off Medicaid for bureaucratic reasons, such as failing to produce documents on time, according to KFF, a nonprofit health policy research group.
The study, published Monday, uses data from the Census Bureau’s survey of health insurance enrollees from late March 2023 to October 2023, focusing on a group of Americans who lost coverage for technical reasons.
There is little data from the unwinding to help researchers and federal officials understand who will be most affected by shrinking Medicaid rolls.
The Centers for Medicare and Medicaid Services does not require states to report enrollment decisions during unwinding by race or ethnicity. Only about 10 states shared that data with the Biden administration.
“This data is very important and it’s information that we don’t have,” said Jennifer Tolbert, a Medicaid and state health policy expert at KFF.
The study did not determine whether Blacks and Hispanics were more likely than whites to lose Medicaid, only that it showed a disproportionate number who failed to complete the renewal process.
Dr. Zhu acknowledged other limitations to the study. Because the data is self-reported, he said, some Medicaid recipients may have lost coverage because they were no longer eligible and believed they had been dropped from the program for bureaucratic reasons.
Health policy experts say the study shows how widespread and varied Medicaid administration is, with sometimes significant demands on enrollees who may not have internet access or the ability to renew coverage in person with state officials.
Ms. Tolbert pointed to the findings of a recent KFF survey that showed Black and Hispanic adults are more likely than white adults to be asked to prove residency as part of their Medicaid coverage renewal.
States also use different technologies and procedures to review Medicaid eligibility, some of which are flawed and unfairly disqualify recipients from the program.
The difference in the country’s unwinding strategy has “big implications on people’s ability to register or renew coverage,” Ms. Tolbert said.
Dr. Zhu said revising the study’s findings should be “low-hanging fruit.”
“Do we have the right contact information? which should be easy to overcome, and by overcoming it can limit the disturbance.”