Why Medicaid’s ‘Undercount’ Drawback Counts

Tens of millions of individuals had been shocked to seek out themselves booted from Medicaid over the previous 12 months after pandemic-era protections expired that had prevented states from terminating their protection.

Seems, thousands and thousands of them had been additionally unaware they’d been coated by the federal government program.

Almost 1 in 3 individuals enrolled in Medicaid in 2022 — or 26 million individuals — didn’t comprehend it, in keeping with a examine by Harvard and New York College researchers revealed in Well being Affairs this month. 

The report estimated that of those that didn’t know they had been on Medicaid, about 3 million thought they had been uninsured.

They virtually actually had protection, although, as a result of the federal authorities from March 2020 to April 2023 prohibited states from dropping anybody from Medicaid rolls in change for billions of {dollars} in pandemic reduction cash.

“What this implies is individuals might have been accessing health-care providers and doubtless didn’t as a result of they thought they had been uninsured,” mentioned Jennifer Tolbert, deputy director of the KFF Program on Medicaid & Uninsured. “Folks not understanding that they’ve Medicaid isn’t factor.”

This lack of knowledge has implications for efforts to foretell how a lot the nation’s uninsured fee has modified because of the Medicaid “unwinding” — the method that started final 12 months wherein states redetermine whether or not individuals enrolled in this system because the pandemic unfolded stay eligible.

States have dropped about 22 million individuals from Medicaid prior to now 12 months, typically for procedural causes like failing to return paperwork. A KFF survey in April discovered about 1 in 4 adults who had been disenrolled from Medicaid a 12 months in the past remained uninsured.

One group enjoys some upside from Individuals’ ignorance about their insurance coverage protection: the businesses that administer Medicaid for many states, together with UnitedHealthcare and Centene

States pay them a month-to-month payment for each particular person enrolled of their plans. But when individuals don’t know they’re insured, they’re much less prone to search well being providers — which implies increased earnings for the businesses.

“Insurers reaped windfalls from this actuality,” mentioned Brian Blase, president of the Paragon Well being Institute and a former well being coverage adviser to President Donald Trump. “People who find themselves enrolled however don’t know they’re enrolled obtain no profit from this system.”

In March 2022, the Facilities for Medicare & Medicaid Companies reported that about 88 million individuals had Medicaid protection. However census survey knowledge discovered about 62 million individuals self-reported Medicaid protection — an undercount of 26.4 million, the examine mentioned. 

A number of elements clarify why enrollees could not understand they’re on Medicaid.

They don’t pay month-to-month premiums, so the price of the protection will be invisible. As a result of it’s administered by personal insurers, many Medicaid recipients could consider they’ve industrial protection. And states typically market their Medicaid packages with a consumer-friendly title, like Husky Well being in Connecticut or SoonerCare in Oklahoma. 

“Medicaid having completely different names shouldn’t lead individuals to suppose they’re uninsured,” mentioned Benjamin Sommers, a well being economist at Harvard who was one of many examine’s authors.

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KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Study extra about KFF.


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