Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of a sweeping the unfolding of policy since the pandemic which prohibited states from removing people from the program.

Early data show that many people lost coverage for procedural reasons, such as when Medicaid recipients didn’t return paperwork to verify their eligibility or couldn’t be found. The large number of terminations for procedural reasons suggests that many people may be losing their coverage even if they still qualify for it. Many of those dropped were children.

From the start of the pandemic until this spring, states were barred from kicking people off Medicaid under a provision in the coronavirus relief package passed by Congress in 2020. The guarantee of continuous coverage spared people regular eligibility checks during the public health crisis and caused Medicaid enrollment to soar to record levels .

But that policy expired at the end of March, setting in motion a massive red tape across the country to verify who still qualifies for coverage. In recent weeks, states have begun releasing data on who has lost coverage and why, offering the first glimpse of the punishing toll the so-called rollout is taking on some of the poorest and most vulnerable Americans.

At least for now 19 states they started removing people from roles. The exact total number of people who lost coverage is not yet known.

In Arkansas, more than 1.1 million people — more than a third of the state’s population — were on Medicaid at the end of March. In April, the first month states could start kicking people out of the program, approx 73,000 people lost coverageincluding about 27,000 children under 17 years of age.

Among those cut was Melissa Buford, a diabetic with high blood pressure who makes about $35,000 a year at an east Arkansas health clinic helping families find affordable health insurance. Her two adult sons also lost coverage.

Like more than 5,000 others in the state, Ms. Buford, 51, was no longer eligible for Medicaid because her income had increased. The notice telling her she was ineligible upset her enough to throw it in the trash.

But most of those who lost coverage in Arkansas were dropped for procedural reasons.

Daniel Tsai, a senior official at the Centers for Medicare and Medicaid Services who is helping oversee the rollout process for the Biden administration, said more help is needed for those who have lost coverage this way. He said federal officials are in regular contact with state officials around the country to review early rollout data and check whether people who lost coverage had a fair chance to prove eligibility.

Gov. Sarah Huckabee Sanders of Arkansas, a Republican, has called the rollout a necessary process that will save money and allow Medicaid to operate within its intended scope.

“We are simply removing ineligible participants from the program to reserve resources for those who need them and to comply with the law,” Ms. Sanders wrote opinion essay in The Wall Street Journal this month. She added that “some Democrats and activist reporters oppose Arkansas’ actions because they want to keep people dependent on government.”

Funded jointly by the federal government and states, Medicaid is becoming an increasingly far-reaching part of America’s safety net. Earlier this year, 93 million people — more than one in four Americans — were enrolled in Medicaid or Children’s Health Insurance, up from 71 million before the pandemic.

What has happened so far in Arkansas offers evidence of the widespread disruption the rollout process will likely cause in households across the country in the coming months, forcing Americans to find new insurance or figure out how to regain the Medicaid coverage they lost. procedural reasons. The federal government estimates that about 15 million people will lose coverageincluding nearly seven million people who are expected to be phased out even though they are still eligible.

Among the biggest questions that arise is how the process will affect children. In Florida, for example, a boy in remission from leukemia and needs a biopsy recently lost coverage.

Researchers at the Georgetown University Center for Children and Families estimated before the unraveling that more than half of the children in the United States they were covered by Medicaid or CHIP. Many children who lose coverage will be dropped for procedural reasons even though they are still eligible, said Joan Alker, the center’s executive director.

“Those kids have nowhere else to turn for coverage,” she said. “Medicaid is the largest insurance company for children. That’s extremely important to them.”

In Arkansas, many of the children who lost Medicaid were “the poorest of the poor,” said Loretta Alexander, director of health policy for Arkansas Advocates for Children and Families. She added that losing coverage would be particularly harmful to young children, who need regular developmental check-ups at an early age.

Most states take about a year to complete the rollout, each using their own approach to removing people from Medicaid. But in Arkansas, legislation passed in 2021 required state officials to complete the process in just six months. State officials checked the eligibility of children with Medicaid coverage early in the process because they make up a substantial portion of children enrolled, according to Gavin Lesnick, a spokesman for the state Department of Human Services.

In her essay, Ms. Sanders pointed to a campaign the state launched to alert residents to the release, the so-called Restore Arkansas.

“We have hired additional staff and enlisted volunteers to help,” she wrote. “We’ve texted, emailed and called tens of thousands of Arkansans who may not be eligible for Medicaid right now, and we’ve made a special effort to reach out to people with disabilities, those who have moved, people with illnesses like cancer, those , who are receiving dialysis and women who are pregnant.”

Local health workers like Ms. Buford are trying to help people regain coverage if they’re still eligible. She said she worked with 50 to 75 Medicaid recipients who lost coverage in April, helping them fill out forms or answering their questions about how to verify their eligibility.

Other states have also eliminated large numbers of Medicaid recipients for procedural reasons. In Indiana, nearly 90 percent about 53,000 people who lost Medicaid in the first month of the state’s rollout were deployed for these reasons. In Florida where almost 250,000 people lost Medicaid coverage, largely due to procedural reasons.

In addition to different approaches to removing people from Medicaid, states also release data on their progress in different ways, making it difficult to compare their strategies in the early stages of rollout. “We’re comparing apples to oranges and tangerines,” Ms Alker said.

Some people who lose Medicaid coverage are expected to get health insurance through their employer. Others will likely turn to the Affordable Care Act’s marketplace to sign up for private insurance, and many will qualify for no-premium plans.

Debra Miller, 54, of Bullhead City, Arizona, lost her Medicaid coverage in April after her roughly $25,000 a year salary as a Burger King cook made her ineligible. Ms. Miller, a single mother with diabetes and hypothyroidism, worked with an insurance adviser at North Country HealthCare, a network of federally funded health clinics, to enroll in a marketplace plan for about $70 a month.

“It’s a struggle because it’s a new account that I haven’t had before,” she said. She added that her new plan doesn’t include vision insurance, so she worries about paying for the eye appointments she needs as a diabetic.

Ms. Buford said that for some people in Arkansas, market coverage would be too expensive.

“You have a car, a mortgage, kids, food,” she said. “You really don’t have that much left to pay that much for health insurance.”

Ms. Buford said her work helping others find health insurance in underserved areas was a vocation inspired by watching her grandmother struggle to afford medicine and rely on food supplies. Mrs. Buford attended a community college near her hometown to care for her ailing father, who died in her 40s. “I love my job because I get to help people,” she said.

Now that she has lost her Medicaid coverage, Ms. Buford said she hopes to find an affordable marketplace plan in the near future. According to her, the family plan offered by the clinic where she works is too expensive.

“I’m thankful for what I have because somebody else doesn’t have what I have,” Ms. Buford said. “I just wish I could keep my Medicaid.

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