Medicaid has grown a lot during the pandemic. Soon it will shrink again. : Blows


George Mink Jr. is a health worker in Delaware County, Pennsylvania. He worries about what will happen when vaccines are no longer paid for by the federal government. (Kimberly Paynter/WHYY)

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George Mink Jr. is a health worker in Delaware County, Pennsylvania. He worries about what will happen when vaccines are no longer paid for by the federal government. (Kimberly Paynter/WHYY)

Kimberly Paynter / WHY

Robert, who lives in Philadelphia, knows enrolling in Medicaid can be tricky with his ADHD, so he brought his daughter with him to help with the paperwork.

“If we missed a little detail, they would reject you,” says Robert, who has benefited from government health insurance for low-income people in the past. “I usually get two applications, so if I’m wrong on one, I can do the other.”

This time, with the help of his daughter, the application only took Robert half an hour. (NPR agreed to use Robert’s first name only because he has a medical condition he would like to keep secret.)

Properly enrolling in Medicaid is poised to become a milestone again for enrollees after a three-year hiatus from paperwork hurdles. In 2020, the federal government recognized that a pandemic would be a bad time for people to lose access to medical care, so it required states to keep people on Medicaid while the country was in an emergency. of public health. The pandemic continues, as does the public health emergency, last renewed on January 11.

But Medicaid’s special measure called “continuous enrollment” will end on March 31, 2023 no matter what. This was part of the budget bill that Congress passed in December 2022. Even if the public health emergency is renewed in April, states will begin requiring people on Medicaid to re-enroll to renew their coverage. And that means between 5 and 14 million Americans could lose their Medicaid coverage, according to the Kaiser Family Foundation, the nonpartisan health policy organization.

The federal Department of Health and Human Services expects 6.8 million people to lose coverage even though they are still eligible, based on historical trends in paperwork and other administrative hurdles. Before the pandemic, some states made it very difficult to enroll and re-enroll in Medicaid to keep people from being enrolled.

During the three years of the pandemic, the number of Americans on Medicaid and CHIP – the Children’s Health Insurance Program – rose to 90.9 million, an increase of nearly 20 million.

Jenn Lydic is director of social services and community engagement at the Public Health Management Corporation, a nonprofit organization that operates six health centers in Philadelphia. She says the reprieve from renewal formalities “has allowed for a continuity that I think has really saved a lot of people’s lives.”

“I know so many patients who have now been able to really get ahead of many of their health issues,” Lydic says.

Research shows that disruptions to Medicaid coverage can lead to delayed care, less preventative care, and higher health care costs associated with unmanaged chronic conditions like diabetes and drug use disorders. substances.

Philadelphia Health Commissioner Cheryl Bettigole has worked in the city’s health centers for years. She said continued Medicaid enrollment and pandemic measures like free access to COVID-19 testing and treatment have been a big step forward. She would like to see some of it last.

“There was this moment with the pandemic where we recognized that it was really important that everyone had access to care. And we kind of changed our minds about that,” says Bettigole. “If we were to have a newer, better vaccine that lasts longer, we would want everyone to get it. We recognized that for a while, for one condition, and now we’re kind of coming back to that. I really think it’s a shame.”

Bolstered Medicaid rollovers mean the country has a historically high insured rate of 92%. This rate is likely to erode as Medicaid declines again. States have some discretion on how they restart the registration process. It can take a few months to a year. If a state finds that a person is no longer eligible for Medicaid, they won’t be immediately disqualified, said Jennifer Tolbert, associate program director on Medicaid and the Uninsured at the Kaiser Family Foundation. The Pennsylvania Department of Social Services said it would take a full year to do so and is working to ensure no one experiences a lapse in health coverage.

The federal government also increased Medicaid funding to states in 2020, and that increased funding won’t start to fade until the end of 2023. Tolbert added that the decision to keep people enrolled in Medicaid permanently is truly unprecedented, but there will be lasting changes from the pandemic.

For example, Oregon will allow Medicaid-eligible children to enroll at birth and remain enrolled until age 6, without having to reapply. Washington, California and New Mexico are also considering similar policies.

Another concern is what happens when the supply of federally funded COVID-19 vaccines and tests ends. Last August, the federal government announced that it no longer had funds from Congress to pay for COVID-19 vaccines. In March 2022, the federal government stopped paying for testing for uninsured patients.

George Mink Jr. is a community activist for Health Educated, a Delaware County nonprofit that has hosted immunization clinics, health fairs, and webinars. He took advantage of free Covid tests and vaccines at the start of the pandemic. Mink said he might not have been tested if he had to have health insurance or pay for it himself. He had no serious health issues, but in 2020 a close family friend died of COVID-19. Mink and her family were tested and found to be positive.

“Who knows what could have happened? he said. “We still would have…infected other people. It made a big difference.”

Mink is also up to date with her COVID-19 vaccinations, but is worried about what will happen when the vaccines are no longer free: “What if in two months we have a new variant coming and now I have need another reminder, and now I can’t afford it?”


Pharmacist Dr. Kristin Motley founded Health Educated, a community-based organization in Delaware County, Pennsylvania. Flyers for the podcast she hosts with George Mink Jr. (Kimberly Paynter/WHYY)

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Pharmacist Dr. Kristin Motley founded Health Educated, a community-based organization in Delaware County, Pennsylvania. Flyers for the podcast she hosts with George Mink Jr. (Kimberly Paynter/WHYY)

Kimberly Paynter / WHY

The Pennsylvania and Delaware health departments have said they plan to continue providing free testing and vaccines for the foreseeable future, and the federal government has yet to say when the free vaccine supply will be available. interrupted.

Pharmacist Kristin Motley, founder of the nonprofit Health Educated where Mink works, will be sorry to see free vaccines disappear.

“It allowed us to go into the community, wherever people were and say, you don’t have to sign up, you don’t have to bring ID, you don’t have to. you don’t need to bring insurance. You just come,” she said. . “It was really nice to be able to help people in this way without paperwork, without bureaucracy. It was so transparent.”

Medicaid has grown a lot during the pandemic. Soon it will shrink again. : Blows

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