KFF: Medicaid Unwinding: A population larger than the state of Louisiana has lost healthcare coverage for procedural reasons so far.

I haven't checked in on how many Americans have lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally since the end of July. Fortunately, KFF (formerly the Kaiser Family Foundation) has been diligently tracking the data, and it continues to be extremely depressing and concerning.

At the time, "only" 3.77 million people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).

KFF's data is now pretty comprehensive (it includes nearly every state plus DC), and it's bad if not worse than many healthcare advocates feared as the numbers have continued to grow dramatically:

• At least 6,428,000 Medicaid enrollees have been disenrolled as of September 12, 2023, based on the most current data from 48 states and the District of Columbia. Overall, 36% of people with a completed renewal were disenrolled in reporting states while 64%, or 10.8 million enrollees, had their coverage renewed (two of the reporting states do not provide data on renewed enrollees). Because not all states have publicly available data on total disenrollments, the data reported here undercount the actual number of disenrollments.

• There is wide variation in disenrollment rates across reporting states, ranging from 69% in Texas to 9% in Michigan. Differences in who states are targeting with early renewals as well as differences in renewal policies and system capacity likely explain some of the variation in disenrollment rates. Some states (such as Texas and South Carolina) are initially targeting people early in the unwinding period that they think are no longer eligible or who did not respond to renewal requests during the pandemic, but other states are conducting renewals based on an individual’s renewal date. Additionally, some states have adopted several policies that promote continued coverage among those who remain eligible and have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems.

In and of itself, this isn't necessarily terrible, since many of those losing coverage really aren't eligible for Medicaid/CHIP coverage any longer. It's the next bullet point which is the real problem: A huge portion of those losing coverage may still very well be eligible:

• Across all states with available data, 72% of all people disenrolled had their coverage terminated for procedural reasons. There is also wide variation in rates of procedural disenrollments across states reporting this breakout, ranging from 99% in New Mexico to 17% in Michigan. Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage. Some states, such as Maine, have temporarily paused procedural terminations for some enrollees while the states address problems in the renewal process that lead to increased procedural disenrollments.

In short, at least at least 4.63 million people have lost Medicaid/CHIP coverage for purely procedural/red tape reasons. If this population was its own state, it'd be the 25th largest in the United States, just above Louisiana.

Oh yeah...and it gets worse:

• Although data are limited, children accounted for over four in ten (42%) Medicaid disenrollments in the 16 states reporting age breakouts. As of September 12, 2023, at least 1,278,000 children had been disenrolled out of 3,050,000 total disenrollments in the 16 states. Because Texas has one of the largest Medicaid programs, and because of the limited number of states reporting, Texas has a disproportionate impact on the share of children disenrolled. The share of children disenrolled ranged from 81% in Texas to 18% in Massachusetts.