States can start removing people from Medicaid and the Children's Health Insurance Program on April 1 as Covid-era rules come to an end, kicking off a process that is expected to reduce participation in the programs by more than 15 million people nationwide.
During the pandemic, temporary federal rules prohibited states from removing people from Medicaid and CHIP, even if they no longer qualified or had failed to meet local requirements. As a result, the number of participants soared, reaching more than 91 million by October 2022 — an increase of roughly 20 million relative to the start of the pandemic, according to the Kaiser Family Foundation. But even before President Joe Biden indicated that the Covid-19 emergency would be coming to an end on May 1, Congress decided to end the so-called continuous enrollment provision on April 1.
Five states — Arizona, Arkansas, Idaho, New Hampshire and South Dakota — say they will start ending coverage right away. Other states will move more slowly, but the purge is expected to be completed in most states within the next 14 months.
In some states, the reduction will be quite significant. In Arkansas, for example, officials say that 587,000 people currently on Medicaid no longer qualify — nearly half the state’s total. State officials expect to complete the purge of its health care rolls in just a few months.
Worries about pushing too hard: Federal officials are concerned that some states will move too aggressively to deny Medicaid coverage, especially in places where public-funded services are demonized as socialism or welfare.
All states are now required to send monthly reports on their efforts to purge their health care rolls to federal officials. The data will include the number of current participants who were removed from Medicare and CHIP, as well as a breakdown of the reasons for doing so. The information will be public, though there will be delays, with the first reports not becoming available until summer. Health and Human Services Secretary Xavier Becerra is empowered to intervene if states violate the rules governing the process.
Even under normal conditions, though, state agencies eliminate many people from their health care programs for reasons that have more to do with red tape than actual eligibility. As Washington Post columnist Catherine Rampell points out, nearly half of the people who are expected to lose their Medicaid coverage in the coming months will be eligible to stay in the program. “Among children, the share is even higher: 72 percent of children expected to lose their Medicaid or CHIP coverage will technically still be eligible for Medicaid or CHIP,” Rampell writes.