Why Medicaid’s ‘Undercount’ Drawback Counts


Hundreds of thousands of individuals have been stunned 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 have been additionally unaware they’d been lined by the federal government program.

Practically 1 in 3 individuals enrolled in Medicaid in 2022 — or 26 million individuals — didn’t realize it, in line with a research by Harvard and New York College researchers printed in Well being Affairs this month. 

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

They nearly 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 aid cash.

“What this implies is individuals may have been accessing health-care companies and doubtless didn’t as a result of they thought they have 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 knowledge has implications for efforts to foretell how a lot the nation’s uninsured price has modified because of the Medicaid “unwinding” — the method that started final yr through which 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 previously yr, usually for procedural causes like failing to return paperwork. A KFF survey in April discovered about 1 in 4 adults who have 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 charge 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 companies — which suggests larger 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 research mentioned. 

A number of components 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 imagine they’ve industrial protection. And states usually market their Medicaid applications with a consumer-friendly identify, 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 research’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. Study extra about KFF.

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