By skyforbes 
Medicaid is a government-funded healthcare safety net program providing medical assistance to low-income and vulnerable Americans. Because of the COVID-19 public health emergency declaration, Congress enacted Medicaid continuous coverage with the prevention of termination of coverage for most beneficiaries from March 2020 to April 1, 2023.
This week marks the resumption of standard Medicaid enrollee eligibility determination measures, with the immediate termination of coverage for those found ineligible. Critically, this also means the potential termination of Medicaid eligibility for approximately 18 million Americans covered under the program since March 2020, even if many may remain Medicaid eligible but “lost” due to myriad administrative complexities to maintain coverage.
If this transition is not well managed, it is essential to consider the adverse outcomes Americans covered under the program may face.
Reduced Healthcare Access and Treatment
Losing Medicaid coverage will significantly reduce access to healthcare services, potentially leading to untreated illnesses and worsening chronic conditions. It also reduces access to prescription drugs, mental health services, dental care, and other benefits. These factors only exacerbate existing health inequities and disparities in the United States. Low-income Americans, people of color, and people with disabilities are already more likely to experience poor health outcomes and have less access to healthcare services. These disparities predictably become even more pronounced if these individuals lose their Medicaid coverage.
Such cuts to those receiving Medicaid increase health care costs for everyone, as uninsured individuals are more likely to seek care in emergency departments, may require more hospitalization, and incur greater medical debt, all caveated by potential suboptimal health outcomes due to delayed or absent healthcare access.
In response, many will forego needed care once again.
Reduced State Funding
Ongoing Capitol Hill wrangling creates a real risk of reduced funding and benefits for the Medicaid program. Many states have already faced significant budget constraints due to the pandemic, and the end of enrollment restrictions could further strain their finances. Such conditions could result in states cutting back on benefits, reducing the number of people covered under Medicaid, or both. It could also impact the broader economy, as individuals unable to access medical care may be less productive or forced to miss work due to illness.
Re-enrollment Delays, Eligibility, and Gaps in Coverage
Another concern is the potential for re-enrollment delays and gaps in coverage. As states begin to reinstate their standard Medicaid enrollment procedures, some individuals who lost coverage due to pandemic-related freezes may need to reapply. Before the pandemic, some states required Medicaid recipients to regularly renew their coverage, often by providing documentation or answering questions about their income and other eligibility criteria. As states reinstate these requirements, some individuals may be unable to meet them, resulting in the loss of their Medicaid coverage. Meeting these administrative requirement steps could be particularly challenging for those with unstable employment or housing, those with limited access to the documentation they need to prove their eligibility, have limited access to technology, or face other barriers to enrollment.
Administrative Challenges
Finally, ending enrollment restrictions could pose significant administrative challenges for states and Medicaid beneficiaries. Re-enrollment and reinstatement processes — managing any structural policy and funding changes to the program — could be complex and time-consuming. For states, this could increase administrative costs, staff workload, and potential delays or errors in enrolling beneficiaries or processing benefits. For beneficiaries, it could lead to confusion, frustration, and possible errors in their coverage or benefits.
These administrative challenges could have serious consequences for both states and beneficiaries, potentially reducing the effectiveness of the Medicaid program and increasing the burden on an already overburdened healthcare system — especially across essential primary care services.
The end of pandemic restrictions on Medicaid eligibility may significantly impact the estimated 18 million Americans who rely on Medicaid for access to healthcare and other essential services but now face loss of coverage. The expiry date of pandemic restrictions on Medicaid eligibility was not unknown. Over the past two years, CMS has provided states specific guidance on managing and streamlining this transitional period. States must now be well underway in implementing or accelerating strategies to mitigate negative outcomes by ensuring sustained access to affordable healthcare services for many of our most vulnerable citizens.