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One year after unwinding, community health centers struggle with Medicaid re-enrollment

12 Apr 2024 1:57 PM | Addie Thompson (Administrator)

Almost all community health centers (95%) are reporting Medicaid disenrollment, influencing the level of care provided to individuals that rely on these locations.

Three-quarters of people who have lost Medicaid coverage are still disenrolled, a new survey of national community health centers finds. Many of these individuals are likely unable to find commercial health insurance.

A breakdown of Medicaid disenrollees from community health centers shows the widespread impact. Of the affected individuals, 32% have chronic conditions, 24% are children, 12% were adults older than 65 years of age and 12% had disabilities.

The analysis was conducted by the National Association of Community Health Centers and the George Washington University's Geiger Gibson Program in Community Health from January to February 2024.

“Health centers are sounding the alarm on unwinding with nearly a quarter of their Medicaid patients, including children and older adults, losing coverage,” said Peter Shin, Ph.D., research director of the Geiger Gibson Program, in a news release. “The reported proportion of patients who are not seeking care or continuing treatment is also substantial and highly concerning.”

During the public health emergency, Medicaid enrollment increased more than 30% to over 23 million people. States began the unwinding process April 1, 2023, and enrollment now sits at 85 million people, said Jennifer Tolbert, director of state health reform for KFF, in a recent webinar on the unwinding's impact.

Enrollment has declined in all states except Hawaii, due to a procedural pause brought on by the Maui wildfires in August, but states are at different levels of processing renewals and enrollment varies greatly.

"We find mild, but positive, correlation between the number of e14 waivers a state has adopted and enrollment decline," she explained.

These waivers can increase ex parte (automatic) renewals, help enrollees submit renewal forms, update contact information or facilitate reenrollment for people affected by procedural terminations, KFF reported. Only Florida has not utilized any waivers.

She expects the Centers for Medicare & Medicaid Services to release a timeline showing each state's progress soon, though some states likely won't be done with the unwinding process until the fall.


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