Black and Hispanic adults were twice as likely than their White peers to be unable to renew their Medicaid enrollment after the end of the COVID-19 public health emergency (PHE) in spring 2023, a Northwestern University–led study estimates.
For the study, published in JAMA Internal Medicine, the researchers analyzed data from seven waves of the US Census Bureau's Household Pulse Survey to estimate the racial distribution of adult Medicaid disenrollment from March to October 2023.
75% of disenrollments due to administrative issues
A record 94 million Americans were continuously enrolled in Medicaid during the COVID-19 PHE, the study authors noted.
"Since the continuous enrollment provision ended March 31, 2023, approximately 10 million people have lost Medicaid coverage as states began redetermining enrollees’ Medicaid eligibility (unwinding period)," they wrote. "Three-quarters of disenrollments occurred for procedural reasons, including incomplete applications, application errors, and inaccurate contact information."
Because roughly 60% of Medicaid enrollees are of minority race, experts worry about racial disparities in procedural disenrollment that could lower healthcare access and use—especially among Black and Hispanic adults. "However, state-level information on causes of procedural disenrollments is limited, and only 9 states currently report disenrollments by race and ethnicity," the researchers said.
Making enrollment less arduous
Medicaid disenrollments rose substantially when the PHE ended in April 2023. By October 2023 (the most recent wave assessed), about 32.4 million adults were on the Medicaid rolls. The average enrollee age was 51.6 years, 62.6% were women, 52.0% were White, 19.9% were Hispanic, 17.7% were Black, 4.5% were Asian, and 5.9% were another race.
Of the 5 million adults dropped from Medicaid, 57.3% said they no longer qualified, 17.4% of whom said they couldn't complete the renewal process. A greater percentage of adults unable to complete the renewal process were Black or Hispanic, compared with overall proportions of Black (22.0% vs 16.4%) and Hispanic (33.5% vs 22.7%) enrollees.
Black and Hispanic enrollees were about twice as likely as their White counterparts to report losing Medicaid coverage because they couldn't complete the renewal process (adjusted odds ratios, 2.19 and 2.08, respectively).
Addressing these barriers may include more transparent race and ethnicity data reporting, expedited administrative processes, expanded renewal assistance, and prioritized redeterminations for beneficiaries most likely to be ineligible.
"A lot of people got kicked off Medicaid for administrative reasons," senior author Jane Zhu, MD, MPP, MSHP, of Oregon Health & Science University (OHSU), said in an OHSU press release. "Our study found that Black and Hispanic people are twice as likely to lose Medicaid insurance for reasons that can be addressed by systems improvements."
The investigators recommended that policymakers reduce racial health disparities by improving Medicaid enrollment processes. States, they added, could make the renewal process less complex by populating renewal forms with enrollee data or allowing more time to return forms.
"Addressing these barriers may include more transparent race and ethnicity data reporting, expedited administrative processes, expanded renewal assistance, and prioritized redeterminations for beneficiaries most likely to be ineligible," they wrote.
