Why Medicaid’s ‘Undercount’ Downside Counts

4 min read

Thousands and thousands of individuals had been shocked to search out themselves booted from Medicaid over the previous yr after pandemic-era protections expired that had prevented states from terminating their protection.

Seems, tens of millions of them had been additionally unaware that they had been coated by the federal government program.

Almost 1 in 3 folks enrolled in Medicaid in 2022 — or 26 million folks — didn’t comprehend it, in line 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 definitely 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 trade for billions of {dollars} in pandemic reduction cash.

“What this implies is folks may have been accessing health-care companies 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. “Individuals not understanding that they’ve Medicaid is just not factor.”

This lack of information 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 yr through which states redetermine whether or not folks enrolled in this system because the pandemic unfolded stay eligible.

States have dropped about 22 million folks from Medicaid previously yr, 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 yr 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 price for each individual enrolled of their plans. But when folks don’t know they’re insured, they’re much less more likely to search well being companies — which suggests increased income 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 folks had Medicaid protection. However census survey information discovered about 62 million folks self-reported Medicaid protection — an undercount of 26.4 million, the examine mentioned. 

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

They don’t pay month-to-month premiums, so the price of the protection might be invisible. As a result of it’s administered by non-public insurers, many Medicaid recipients might imagine they’ve business protection. And states typically market their Medicaid applications with a consumer-friendly identify, like Husky Well being in Connecticut or SoonerCare in Oklahoma. 

“Medicaid having completely different names shouldn’t lead folks 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 without doubt one of the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.

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