Medicaid is falling down in front of us and taking American families with it

If you care about women’s health, or the health of the U.S. economy for that matter, you should be paying attention to Medicaid.

Medicaid,  the publicly funded health insurance program designed to provide a safety net for low-income and disabled Americans, is unraveling at an alarming pace  — and that’s bad news for women, families, communities and the nation as a whole.

In 2021, Medicaid paid for 2 out of 5 births in America. And, of the nearly 95 million Medicaid beneficiaries in early 2023, 46 percent were children.

As millions of people were losing their jobs or stepping away from paid work to care for their children during the pandemic, Medicaid was a lifeline. Between February 2020 and February 2023, the Medicaid rolls grew by nearly 23 million, thanks in part to provisions in the Families First Coronavirus Response Act that required states to keep people enrolled in coverage through the end of the public health emergency. 

Yet even before the public health emergency officially ended in May, Congress had given states the greenlight (via the Consolidated Appropriations Act) to start dropping people from Medicaid. Continuous enrollment rules ended on March 31, and it hasn’t taken long for states to get to work disenrolling people. By mid-June, more than a million people had already lost Medicaid benefits, and the Kaiser Family Foundation (KFF) estimates that approximately 8 million to 24 million could be disenrolled within 12 months. Certain groups are more likely to lose coverage than others, according to KFF, as a result of barriers in the renewal process. These groups include people who have moved, immigrants and people with limited English proficiency, people with disabilities and older adults.

Many, if not most, people who lose coverage in the renewal process won’t be covered any other way; they’ll simply be uninsured. People lose Medicaid for substantive eligibility reasons, such as getting a job with better wages and benefits. When that happens, those people no longer need the safety net. But most Medicaid enrollees don’t suddenly earn too much to qualify for public benefits. Rather, many lose Medicaid because of administrative reasons: They don’t return paperwork asking them to verify their income or their mail gets returned to sender and the Medicaid agency uses that as a flimsy pretext to disqualify them, presuming they’ve moved out of state and no longer qualify. 

While it’s important not to use precious public dollars for people who don’t need assistance, too often, Medicaid disenrollment hits hardest for people who most need help: those who are living in poverty, often in unstable housing and juggling the demands of caring for children and trying to earn a living wage. They are mothers and caregivers trying to get by. Among non-elderly enrollees who do not have a disability, 61 percent work full- or part-time. 

Who among us hasn’t forgotten to fill out a form when we’re drowning in extraordinary or even routine hassles of life? But for women on Medicaid, failing to return a government form or forgetting to update the state agency with a new address can mean the difference between access to vital healthcare services and going without care, potentially letting small problems become big ones or missing serious diagnoses that need attention. Without insurance and no means to pay out of pocket, more women will simply skip needed care, including preventive tests such as mammograms, Pap tests and colonoscopies. Deferred care and screening will lead to more diagnoses that are more serious and harder and more expensive to treat. 

The impact goes beyond any individual woman. When moms and caregivers aren’t well and can’t take care of themselves, their families suffer. Women miss work or the chance to get meaningful employment. Not only do those women and their families risk falling deeper into poverty, their communities and the economy as a whole miss out on their productive contributions. It’s an economic drag for everyone when sizable portions of the population are held back by ill health and lack of access to preventive care.

The Centers for Medicare and Medicaid Services is urging states to move slowly and spread out the renewal process over 12 months. They are encouraging states to conduct public awareness campaigns to educate residents about the process to avoid unnecessary disenrollments. And they’re recommending that state Medicaid agencies collaborate with private- and public-sector partners to reach the people who need to know that their health coverage is at risk so they can take actions to stay covered if they’re eligible.

States should do all that and more. In particular, states should recognize Medicaid as more than a public expenditure. It is also an economic engine. A Commonwealth Fund analysis showed that expanding Medicaid would create billions in new state revenues and more than 1 million new jobs. And, Medicaid can be a force for improving equity in society by ensuring that women have the means to take care of themselves and their families.

It is essential that states demonstrate that they care about women, their children and families by preserving Medicaid access for those who need it. The health of their economy depends on it. States must reduce administrative hassles and hurdles. They also should flip the script: Instead of looking for any excuse to cut people, states should seek opportunities to ensure continuous enrollment. It’s a good investment in keeping their states healthy, both physically and fiscally.

Martha Nolan is a senior policy advisor at HealthyWomen. HealthyWomen works to educate women ages 35 to 64 to make informed health choices.