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A major civil rights crisis is sneaking up on America. Many observers expect the Biden administration to end the COVID-19 Public Health Emergency in April or July 2023. Whenever that happens, Medicaid will begin terminating families' health care for the first time since February 2020.
Disaster is likely to strike, as state Medicaid agencies struggle to reevaluate the eligibility of more than 82 million people. Federal researchers project that Medicaid will terminate 15 million people—seven times the largest previous annual loss of Medicaid coverage.
More than half of these 15 million people are expected to come from communities of color, including almost 5 million Latinos, more than 2 million African Americans, and nearly a million Asian Americans and Pacific Islanders (AAPI). America's already serious health inequities are about to become far more severe.
Many people who lose Medicaid cannot obtain the health care they need. Chronic conditions like cancer grow undetected until they are more costly to treat and more dangerous, often with grim consequences.
To prevent the greatest loss of Medicaid coverage in American history, Congress should use year-end legislation to stop millions of eligible families from losing health care because of needless red tape.
Nearly 7 million of those expected to lose Medicaid will remain eligible but be terminated for administrative reasons. Paperwork burdens have a particularly significant impact on families under conditions of scarcity. Fully 40 percent of African American beneficiaries, 51 percent of AAPI beneficiaries, and a staggering 64 percent of Latino beneficiaries who lose Medicaid are projected to remain eligible but to be terminated because of failure to meet state administrative requirements.
These projections come with a giant asterisk: They show what is likely to happen if Medicaid operates as it did in the past.
One sobering example comes from Utah, which redetermined eligibility for its Children's Health Insurance Program in 2021. More than 40 percent of all children covered through the program were terminated. For 85 percent of the children who lost coverage, the state had no idea whether they remained eligible. They were dropped because the state never got a response to letters requesting completion of renewal forms.
Similar paperwork-driven terminations contributed to major insurance losses shortly before the pandemic. For example, when Texas ended health coverage for nearly 150,000 children, more than 90 percent of coverage losses resulted from the state not receiving a response to its requests for renewal paperwork.
Tennessee's Medicaid program terminated 11,000 children because they were no longer eligible. The state terminated nearly 13 times as many children—140,000—because the state did not receive complete responses to lengthy renewal packets sent to each family.
Imagine yourself as a parent, fighting to keep above water financially by working low-wage jobs without health benefits. You've relied on Medicaid to cover your children's health care. You bring them to the doctor and find, to your shock, that their Medicaid is gone.
That is the situation families will face as soon as April, unless Congress helps Medicaid return to something much better than pre-pandemic operations.
In partnership with other leading groups, our three organizations are releasing a report today that calls on Congress to prevent a health equity disaster by slashing needless red tape that threatens to terminate Medicaid for millions of eligible children and families.
Such improvements are realistic. States ranging from Alabama to Rhode Island already use data matches to identify most eligible families and renew them without requiring pointless paperwork.
But in states that lag behind their peers, Medicaid terminations should be limited to families who are found ineligible. No one should lose health care because of incomplete or missing forms until their state has done its part to cut needless paperwork.
And unless income information shows likely ineligibility, Medicaid should be renewed automatically whenever people have already been found poor enough to qualify for the Supplemental Nutrition Assistance Program.
97 percent of SNAP recipients under age 65 qualify for Medicaid. Renewing eligibility based on SNAP would strengthen program integrity by preventing numerous erroneous terminations of eligible children and families.
That common-sense step would make a huge difference. Half of all Medicaid beneficiaries receive SNAP, including 55 percent of all Medicaid-enrolled children, 60 percent of American Indian/Alaskan Native beneficiaries, and 70 percent of Medicaid's African American children.
America's leaders have achieved remarkable recent progress. Since 2020 alone, the number of uninsured has fallen by 5.2 million people.
Those hard-won gains could collapse if Medicaid returns to business as usual and 15 million people fall off the program, disproportionately harming communities of color.
Congress proved it can act quickly when it averted a railroad strike that threatened the economy. Now it's time to avert an even greater disaster by preventing millions of eligible families from losing health care because of nothing more than missing paperwork.
Derrick Johnson is President and CEO of the NAACP. Marc H. Morial is President and CEO of the National Urban League. Sonia M. Pérez is Acting CEO and Chief Operating Officer of UnidosUS.
The views expressed in this article are the writers' own.
