Ten million Americans have lost Medicaid coverage as states are deciding who should continue to receive benefits, and more than 70 percent of those who lost coverage did so because of bureaucratic hurdles such as missing paperwork, not because they were shown to be ineligible.  It is likely that two-thirds of those who lost coverage became uninsured either briefly or for a longer period.  More than half of those losing benefits are likely to be people of color. 

These are  major findings of a report released this week by a number of civil rights and human needs groups. It is by far the largest drop in Medicaid coverage in the program’s history. 

The report, Six Months into Unwinding: History’s Deepest Medicaid Losses Demand State Action,  found that more than half of people who lost coverage, or were “disenrolled” from Medicaid, are people of color, assuming disenrollments were proportional to the state’s overall Medicaid population. And it found that states vary widely in how many people they are kicking off the Medicaid rolls; states that invested  in their eligibility system and took steps such as automatically reenrolling beneficiaries who qualify for other programs with similar eligibility standards such as SNAP are dropping far fewer people than states that have not taken those steps. 

The report is co-authored by 10 leading civil rights and health equity organizations: the Asian and Pacific Islander American Health Forum, The Leadership Conference on Civil and Human Rights, NAACP, the National Council of Negro Women, the National Council of Urban Indian Health, the National Urban League, the Southern Poverty Law Center Action Fund, UnidosUS, the Coalition on Human Needs, and Protect Our Care. 

At the onset of the pandemic in 2020, Congress passed legislation to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision, which helped millions maintain health coverage through the worst of the pandemic and led to the lowest level of uninsured Americans ever, expired on April 1, 2023. States then resumed efforts to redetermine eligibility for the approximately 90 million Americans who receive Medicaid benefits. 

In the six months between April 1 and the end of September,  10 million Americans lost Medicaid coverage. Some of those beneficiaries undoubtedly regained coverage through the Affordable Care Act marketplace or through employers’ health plans or were later added back to Medicaid rolls after states corrected their mistakes. Nonetheless, the net contraction of 5.3 million people is the largest in the program’s history – the previous largest drop occurred in 1996 through 1998 when 3.6 million people lost coverage as new, strict federal welfare laws took effect. 

At a news conference accompanying the report’s release this week, members of Congress and civil rights leaders called for a halt to what they called procedural disenrollments – people losing coverage not necessarily because they were no longer eligible but rather due to issues such as missing paperwork or states’ failure to reach beneficiaries. They said the procedural disenrollments should be stopped until states make major reforms that cut disenrollments to levels consistent with the best-performing states. 

The report estimates that more than half of families terminated from Medicaid come from communities of color, including 2.3 million Latinos, 1.8 million African Americans, 400,000 Asian Americans, Native Hawaiians and Pacific Islanders, and more than 400,000 Native Americans. 

The report lists states with the lowest rates of disenrollment – such as Oregon, Minnesota, Illinois, and Maine – and states with the highest rates, such as Nevada, Utah, Texas and Idaho. It notes that states with low disenrollment rates paid an average of $41 per beneficiary for outreach efforts, while states with the highest rates paid an average of $26 per beneficiary for outreach. 

“That’s only a $15 difference,” said said Juliet K. Choi, President and CEO of the Asian & Pacific Islander American Health Forum. “This is where state leadership matters. Investments matter.” 

Leslie Dach, Founder and Chair of Protect Our Care, said states with high disenrollment rates made a “purposeful decision” to not prepare for Medicaid unwinding – and now the results are showing. 

“Many of the states that are failing to keep people covered, like Texas, Georgia, and Florida, are the same ones that have rejected Medicaid expansion, leaving families with no place to turn for basic health care,” he said. “If those states continue on the path of refusing to protect families who rely on Medicaid coverage, the consequences will be devastating, particularly for communities of color and children. Losing access to health care means people won’t get the care they need to stay healthy and thrive, often having to make difficult choices between visiting the doctor or keeping a roof over their heads.” 

A number of speakers urgently noted the fact that the Medicaid disenrollments are having a disproportionate impact on people of color. 

“We cannot afford to roll back the hard-fought progress we have made on Medicaid, which has helped to narrow racial disparities in health coverage and provide much-needed access to life-saving care in communities of color,” said U.S. Rep. Steven Horsford (D-NV), Chairman of the Congressional Black Caucus. “As a result of Medicaid ‘unwinding,’ nearly 1.8 million Black Americans’ Medicaid coverage has been terminated in the last six months because of missing paperwork, which will only exacerbate existing disparities in access to health care for communities that we serve.” 

“We are witnessing the deepest and steepest losses in Medicaid insurance coverage in our nation’s history,” said Eric Rodriguez, Senior Vice President, Policy and Advocacy at UnidosUS. “Communities of color — including 2.3 million Latinos — are bearing the brunt of those losses, making health care unaffordable for them and deepening already serious health inequities across the country. The report finds that most of those that have lost Medicaid health insurance coverage may have still been eligible and that despite having the funds, state leaders did not invest the money needed to protect families from being unjustly dropped from the program.” 

The report notes that if all states achieved the median outcome of the 10 states with the lowest rates of procedural disenrollment, two-thirds of procedural disenrollments never would have occurred. “This means that 4.5 million people would not have been kicked off Medicaid because of missing paperwork,” the report states. 

The report has two primary recommendations for state policymakers. First, they should use reliable data to renew eligible families’ coverage whenever possible – such as participation in SNAP, which is an indicator that families would continue to qualify for Medicaid. Second, states should connect Medicaid families with trained personnel who can help them complete all paperwork needed to determine Medicaid eligibility. 

In the press statement accompanying the report, Deborah Weinstein, Executive Director of the Coalition on Human Needs, said it is “extremely troubling that some states are dropping huge numbers of people from their Medicaid programs because of bureaucratic hurdles, without even knowing whether they remain eligible. States with records so much worse than better-performing states should be required to pause terminations while they improve their systems.” 

You can read the report here and watch the news conference here.