The Threat of Medicaid Disenrollment Continues: What Happens to Those Who are Disenrolled?

Ron Manderscheid, PhD

Adjunct Professor,

University of Southern California

&

Johns Hopkins University

 On four previous occasions, I have reported on Medicaid eligibility redeterminations (frequently referred to as “unwinding”) now being undertaken for the entire Medicaid population by each of the states. Since these redeterminations result in disenrollments from Medicaid, the adverse effects on behavioral health continue to grow.  The need remains for vigilant action.

States are required to undertake this process by the Congressional Consolidated Appropriations Act of 2022, which mandated the end of continuous Medicaid enrollment. Continuous enrollment was initiated during the COVID-19 medical emergency and ended on March 31, 2023. Federal matching funds were phased down by December 31, 2023. States have been undertaking these redeterminations for their Medicaid populations since early in 2023. In the 15 months that redeterminations have been underway, the states have reviewed approximately 85% of their Medicaid populations.

It is very well known that it is exceptionally difficult to enroll people with a mental health or substance use condition in health insurance. It also is true that it is exceptionally difficult to keep such people enrolled. That is why Medicaid redetermination poses a profoundly serious threat to the behavioral health field.

Kaiser Family Foundation (now KFF) estimated at the beginning of the redetermination process that between 8 and 24 million persons would be disenrolled. Assuming a conservative rate of 25% for those with behavioral health conditions in this population, we estimated that between 2 and 6 million persons with mental health or substance use conditions will be disenrolled.

In the redetermination process, states are required to review all Medicaid participants to determine whether they still are eligible for the program. For a portion of these redeterminations, the states use administrative procedures (ex parte) to determine continued eligibility. Such procedures rely on tax and residential data files to make a redetermination. For the remainder, program participants are required to submit new applications that document continued eligibility.

What is the current status of this process?

To date, national data show that about 24.2 million persons already have been disenrolled from Medicaid. Earlier information shows that almost 3 in 4 disenrollments, 70%, were procedural, meaning that the Medicaid recipient did not respond to inquiries for requested information. Further, about 1 in 3 of those with completed renewal applications also were disenrolled.

Earlier data from 20 states show that children constitute about 4 in 10 of those disenrolled. From this, we estimate that, of the 24.2 million people disenrolled, about 9.7 million are children and 14.5 million are adults.

From these facts, we can derive several very important estimates for those with behavioral health conditions. Viewed very conservatively, we estimate today that at least 6.1 million persons with a mental health or substance use condition have been disenrolled, of which 2.4 million are children and 3.7 million are adults.

We are particularly concerned about the children and adults with behavioral health conditions who have been disenrolled. Not only are their numbers tragically large and still growing, but they also contribute to our current national crisis in mental health and substance use care.

New information released by KFF also sheds some important light on this critical issue. Of the 24.2 million persons who were disenrolled, 47% have been re-enrolled in Medicaid, 28% have different insurance (employer sponsored, Medicare, Marketplace, or military), and 23% remain uninsured.

From these facts, we estimate today that of the estimated 6.1 million persons with behavioral health conditions who were disenrolled from Medicaid, at least 1.4 million currently have no health insurance. An additional 2.9 million have been re-enrolled in Medicaid, and 1.7 million have acquired other insurance. Unfortunately, information is not available to break these estimates down by age.

Even though this report contains some good news, ample evidence still exists to provoke continuing concern. Who are these 1.4 million people? How are they coping without health insurance? What role can we play to help them acquire health insurance? Clearly, much more still remains to be done.

© 2024 R. W. Manderscheid