A year ago, states began the process of “unwinding” a yearslong pause to Medicaid redetermination prompted by the COVID-19 pandemic. A Public Health Emergency (PHE) had temporarily guaranteed that no one would lose their Medicaid coverage during the COVID-19 pandemic, driving Medicaid membership to a historic high of 94.5 million in April 2023. With the end of the PHE in May 2023, Medicaid beneficiaries once again must demonstrate that they qualify for the low-income health plan.
What’s happened in the past year? More than 20 million people have been disenrolled from Medicaid so far, a total already greater than the estimate of 15 million from the U.S. Department of Health and Human Service. The total disenrolled is expected to grow, with 36% of renewals still yet to be determined. While some of the people disenrolled are eligible for health insurance coverage through their employers or on the ACA Marketplace, healthcare advocates are focused on ensuring that anyone who qualifies for Medicaid doesn’t fall through the cracks—and that those who qualify for Medicaid are able to continue accessing their life-sustaining care. A recent KFF survey found that nearly a quarter (23%) of those who were disenrolled are now uninsured.
Who Is Being Affected by Redetermination?
In many ways, things are simply returning to normal for state Medicaid programs. It’s a process that inevitably takes time, but so far redetermination seems to be having an unequal impact across the nation, as states have had varying success processing the huge influx of Medicaid applications.
As of mid-April, 69% of all disenrollments were for procedural reasons, meaning Medicaid beneficiaries did not fill out the right paperwork. This can happen for several reasons, such as they never received the forms or they didn’t understand what was required, even if they should still qualify for Medicaid. Some states have much higher rates of procedural disenrollments: In Nevada and New Mexico, they make up 93% of all Medicaid terminations; in Maine, it’s much lower, at 22%.
"Procedural disenrollments are a major concern to us, because it means that consumers who are potentially eligible for Medicaid are losing that coverage and are at risk of becoming uninsured,” said Michael Bagel, Associate Vice President of Public Policy for the Alliance of Community Health Plans. That can cause them to lose the continuity of care “that they so desperately need,” especially in communities that are underserved or struggling with health equity, Bagel said during a recent RISE Medicaid Managed Care Leadership Summit. In late March, CMS issued a new final rule designed to streamline the process of applying and enrolling in Medicaid.
Who has been most impacted by these challenges? First, children, who make up nearly 40% of Medicaid disenrollments in the 21 states that report age. That’s concerning because the bar is supposed to be lower for children, with income limits for children that are higher than they are for adults. Starting this year, states must now provide a year of continuous coverage under Medicaid or the Children’s Health Insurance Program to children under 19, even if their parents no longer qualify.
Second, Medicaid is particularly crucial for vulnerable adults with disabilities or those who have chronic conditions and need regular medical care. At SafeRide Health, we know that Medicaid coverage of non-emergency medical transportation can also be an important lifeline to access that care. When those beneficiaries are left without coverage, it can have negative effects on their mental and physical health.
Medicaid, a First Responder
Why is Medicaid coverage so essential? First, it ensures that low-income state residents can get healthcare even if they can’t afford commercial health insurance or coverage through an ACA Marketplace. Medicaid has also historically been a first line of defense to respond in regional crises such as hurricanes or, as we all know too well, a global pandemic.
For example, the Centers for Medicare and Medicaid Services approved 32 waivers in 2005-06 that extended health coverage to nearly 120,000 evacuees affected by Hurricane Katrina. Similarly, in 2008, a waiver allowed Iowans affected by devastating flooding to delay their applications for Medicaid coverage for three months so those people could focus on recovery.
Without these safety nets, people struggling with life-changing crises would have the added burden of losing their health insurance—possibly impacting their health outcomes—and leaving them vulnerable to serious financial troubles if they need medical care.
SafeRide Health and Medicaid
SafeRide provides transportation for nearly three million people enrolled in Medicaid managed care programs today, and we hear from members every day that these rides play a crucial role in their healthcare, whether they’re traveling to regular appointments to manage chronic conditions, need a ride to their primary care appointment, or need gas mileage reimbursement for their own mode of transportation to get to care. So, the status and impact of redetermination has been front of mind for us.
The past year has reinforced our commitment to putting the member and their experience at the heart of everything we do. When we update our technology and products, we prioritize the member experience. When we train customer service representatives in our call centers, our biggest priority is maintaining the highest level of service for the people who need transportation.
After every ride, we ask passengers how their trip went on a scale of 1-5 (with 5 being best), and our average score across all rides is 4.8. Some people even take the time to praise their driver—in that case, we try to pair that driver and passenger in the future. We also open our all-company meetings by sharing these stories to reinforce the impact we have on members around the country. Transportation represents a personal, humanizing element to healthcare, an industry that has often lacked this. Whether it’s a friend or a loved one, we all know someone who faces barriers to transportation and hearing the real stories of members drive our impact home.
From facilitating innovative alternative transportation options like meals and lodging while a loved one goes through a transplant to helping parents stay close to their newborn in the NICU, our team sees it as more than just arranging and providing a ride. We are helping families navigate what is often a difficult chapter in their lives. We work closely with our Medicaid partners to ensure that each one of these stories is possible.