Health -- July 1, 2022: According to a new analysis by KFF researchers, between 5.3 million and 14.2 million low-income people could lose their Medicaid coverage if the public health emergency ends

and the federal continuous enrollment requirement is lifted. After considering two hypothetical situations about how states would handle the restart of eligibility redeterminations and disenrollments, we arrive at those estimates.

According to KFF analysts, states will have spent $47.2 billion on additional Medicaid beneficiaries from fiscal years 2020 to 2022 as a result of the continuous enrollment requirement, and will have received $100.4 billion in new federal funds to cover those costs and offer general fiscal relief through enhanced Medicaid matching funds.

By the conclusion of the fiscal year 2022, it is predicted that enrollment will have increased by 25%, to a projected 110.3 million, as a result of the analysis. In fiscal 2019, prior to the pandemic, there were 22.2 million more enrollees. The report credits the majority of the rise to the requirement for continuous participation, which prevented churn or brief gaps in coverage caused by registrants joining and leaving the program quickly and helped to ensure coverage for participants during the pandemic.

State officials predicted that the median Medicaid enrollment would decrease by 5% the next year after the public health emergency was declared over in a recent KFF survey of state Medicaid directors in the field in February 2022. Following the elimination of the continuous enrollment requirement, states anticipate that on average, nearly 13% of Medicaid subscribers will be disenrolled, according to a January 2022 KFF study (with estimates ranging from 8 percent to over 30 percent ). The results of this most current study show how much is still unknown about how states will implement the elimination of the continuous enrollment requirement and how many people will lose their insurance.

A 5 percent drop in Medicaid membership would result in a decline of 5.3 million enrollees, and a 13 percent decline in Medicaid enrollment would result in a decline of 14.2 million enrollees, according to the new estimate by KFF researchers based on these survey results. A given state's share of enrollees losing coverage may be lower or greater than these illustrative figures because state estimates varied widely.

As these were the groups that saw the largest growth during the epidemic, the biggest losses are anticipated among children, other individuals eligible for Medicaid other than owing to a disability, and adults made eligible for coverage by the Affordable Care Act's Medicaid expansion. Researchers did not look into how many of those who lose their Medicaid coverage might be able to get coverage elsewhere, such as the ACA Marketplace, how many might go without insurance, and how many might still be Medicaid eligible but encounter difficulties keeping their coverage.

States were granted a 6.2 percentage point increase in the federal Medicaid match rate ("FMAP") in exchange for adhering to the continuous enrollment requirement. This was done to assist states in managing rising enrollment and to quickly provide broader fiscal relief by enabling states to cut state Medicaid spending at a time when states were experiencing significant revenue drops due to the pandemic.

According to KFF analysts, states will eventually have received federal Medicaid funding connected to the pandemic that will more than double the additional state Medicaid costs they had to bear as a result of rising enrollment. Not looked at was how the states applied the financial relief. Even after accounting for the anticipated declines in Medicaid enrollment, state spending on Medicaid is likely to rise when the public health emergency ends and the loss of enhanced federal funds.

Because the additional federal matching money does not apply to the ACA adult expansion population, states that did not expand Medicaid under the ACA tended to receive greater federal fiscal relief during the epidemic.

Wnctimes by Marjorie Farrington 

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