Up to 18 million people could lose Medicaid coverage after COVID-19 PHE

Up to 18 million people could lose Medicaid coverage after COVID-19 PHE

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According to an analysis recently released by the Urban Institute, more than 18 million people could lose Medicaid coverage and 4 million people could no longer be fully insured when the COVID-19 public health emergency expires next year.

It could lead to the biggest changes in coverage since the Affordable Care Act was implemented more than a decade ago, according to the findings.

The most recent data shows that registrations jumped by more than 18 million people from February 2020 to June 2022. This increase in registrations is largely due to the continued coverage requirement of the Coronavirus Response Act of Family First, which has prevented state Medicaid agencies from de-enrolling people during PHE unless they specifically request it.

Using the latest available administrative data on Medicaid enrollment, recent household survey data on health coverage, and the Urban Institute’s health insurance policy simulation model, analysts estimated that About 3.2 million children are expected to transition from Medicaid to separate children’s health insurance programs, so total Medicaid and CHIP enrollment will decline by 14.8 million people.

About 3.8 million people will no longer be insured, the data shows, while about 9.5 million people will re-enroll in employer-sponsored insurance after losing Medicaid, or switch to sponsored insurance. by the employer as the sole source of coverage after being enrolled by both the employer. insurance and Medicaid during PHE.

On top of that, more than one million people will sign up for the out-of-group market, most of whom will be eligible for premium tax credits in the market.

Further extensions of the PHE are possible, according to the Urban Institute. If extended for another 90 days, the number of people losing Medicaid will likely reach nearly 19 million.


The largest portion of Medicaid losers, 9.5 million, will end up with employer-sponsored insurance (ESI), according to the report. Nationally, unemployment is almost back to pre-pandemic levels, and many people will lose their Medicaid eligibility precisely because they found new jobs during PHE. An unknown number of people switching from Medicaid to ESI-only were enrolled in both types of coverage during PHE; the number of new ESI enrollees after the PHE is likely to be considerably less than 9.5 million.

The end of the PHE is still uncertain. If extended for another 90 days, about 1 million more people will lose Medicaid after it expires. The Biden administration has promised to give 60 days notice before the end of the PHE but has resisted demands from many states for more notice.

While nearly 4 million people are at risk of becoming uninsured, people switching from Medicaid to private coverage will pay more in premiums and health costs. It is possible that more people losing Medicaid, especially those who do not have access to ESI, will experience a temporary hiatus in health coverage before enrolling in alternative coverage.

According to the Urban Institute, state policy decisions during the transition after PHE expires will affect how many people lose coverage, how quickly they lose coverage, and how many people enroll in another blanket.

Enrollment in Medicaid during PHE may have other lasting effects, such as raising awareness of changing health insurance coverage and possibly changing perceptions of Medicaid, the authors said. The experience can also inform the debate on other issues related to churn and continuity of coverage, such as 12-month continuous eligibility for Medicaid and better coordination between Medicaid and markets.


The public health emergency will be extended beyond its current deadline of January 11. The new deadline will be in April if extended for another 90 days.

PHE maintains waivers and policies in place for Medicaid coverage, telehealth coverage, and supplemental payments to hospitals and physicians. Telehealth waivers will expire 151 days after the end of the PHE.

Twitter: @JELagasse
Email the author: Jeff.Lagasse@himssmedia.com

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