Why Medicaid’s ‘Undercount’ Drawback Counts

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, hundreds of thousands of them had been additionally unaware that they had been coated by the federal government program.

Almost 1 in 3 individuals enrolled in Medicaid in 2022 — or 26 million individuals — didn’t realize it, in accordance 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 nearly 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 alternate for billions of {dollars} in pandemic reduction cash.

“What this implies is individuals may have been accessing health-care companies and possibly 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 isn’t a very good factor.”

This lack of information has implications for efforts to foretell how a lot the nation’s uninsured fee has modified on account of the Medicaid “unwinding” — the method that started final yr by which states redetermine whether or not individuals enrolled in this system for the reason that pandemic unfolded stay eligible.

States have dropped about 22 million individuals from Medicaid up to now 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 payment for each particular person enrolled of their plans. But when individuals don’t know they’re insured, they’re much less more likely to search well being companies — which suggests greater 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 Providers 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 components clarify why enrollees could not notice they’re on Medicaid.

They don’t pay month-to-month premiums, so the price of the protection could be invisible. As a result of it’s administered by non-public 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 totally different names mustn’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 unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.


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