Blacks and Hispanics are twice as likely to lose Medicaid after COVID-19 eligibility expansion ended

A recent study published in JAMA Internal Medicine has revealed the racial and ethnic disparities in Medicaid disenrollment, as Blacks and Latinos are twice as likely to lose the insurance after the pandemic eligibility expansion ended.

During the COVID-19 public health emergency (PHE), health insurance coverage improved significantly for millions of Americans through Medicaid enrollment (the study estimates that 94 million individuals enrolled). However, since the continuous enrollment provision ended March 31, 2023, approximately 10 million people have lost Medicaid coverage as states began redetermining enrollees' Medicaid eligibility.

The study, conducted by Oregon Health & Science University, Northwestern University, and Harvard Medical School, has revealed a disproportionate impact on Black and Hispanic Americans following the termination of the scheme. It highlights that these groups were twice as likely to lose Medicaid coverage due to administrative issues, compared to white individuals.

The researchers utilized data from the U.S. Census Bureau's Household Pulse Survey to estimate adult Medicaid disenrollment by race and ethnicity during the period when Medicaid was unwinding. The findings are concerning, as they suggest that up to 18 million people could lose Medicaid coverage by May 2024, with many eligible individuals falling through the cracks due to procedural barriers.

"Medicaid eligibility is complex, and then applying and keeping Medicaid coverage is a huge logistical barrier," said one of the study's author, Dr. Jane M. Zhu to The New York Times. "What this analysis is showing is that these barriers have downstream spillover effects on particular communities."

Zhu and her team are calling for policy changes to improve Medicaid enrollment processes and address health disparities. They recommend transparent reporting of race and ethnicity data, streamlined administrative procedures, expanded renewal assistance, and prioritized redeterminations for beneficiaries most likely to be ineligible. These measures aim to prevent disproportionate impacts on vulnerable populations during Medicaid redetermination processes.

Dr. Zhu concluded that these fixes should be "low hanging fruit":

"Do we have the right contact information? Are we sending enrollment and eligibility paperwork to the right people at the right time? Are we considering all different forms of automatically re-enrolling individuals? These are all things that are systems issues, systems barriers that should be easy to address, and by addressing them can limit disruptions."