Democrats have long sought to achieve their goal of a government-controlled single-payer health insurance system, at least in part through the expansion of the Medicaid program for low-income and disabled Americans, and made great progress toward that end as the program was expanded nationwide to include around 20 million additional enrollees during the COVID-19 pandemic.

That could all be reversed in the coming months, though, as congressionally authorized pandemic-era protections for Medicaid enrollees have now been rolled back through another act of Congress, and many of those 20 million new enrollees could soon find themselves uninsured, the Daily Mail reported.

States now permitted to redetermine eligibility of Medicaid enrollees

In March 2020, near the beginning of the coronavirus pandemic, Congress passed the Families First Coronavirus Response Act, which included a provision that temporarily relaxed Medicaid eligibility standards and prohibited states from removing ineligible enrollees from the program in exchange for increased matching funds from the federal government.

The purpose of that move was an effort to ensure that as many Americans as possible had health insurance coverage of some sort in case they were infected with COVID-19, and there was some success in that regard as upwards of 20 million Americans who would otherwise be ineligible for Medicaid were added to or retained by the program nationwide over the past three years.

That was never meant to be permanent, however, and in December 2022 a provision was included within the Consolidated Appropriations Act of 2023 that set a date of April 1 for states to begin a 14-month process to wind down that pandemic-era expansion and return the Medicaid program to normalcy.

That means the individual states are now once again permitted to conduct redeterminations of eligibility for Medicaid enrollees and remove from the rolls those who are not disabled, earn more than a certain amount in annual income, or are enrolled in any other health insurance program.

Process already begun in some states

Politico reported in February that several Republican-led states were ready to immediately begin the redeterminations of eligibility as soon as the prior requirement for continuous coverage was no longer in effect.

One of those states is Arkansas, which at that time had already sent notifications and renewal letters to an estimated 130,000 Medicaid enrollees who had been added or retained over the past three years and who may now no longer be eligible to remain as an enrollee for various reasons.

Gavin Lesnick, a spokesman for the Arkansas Department of Human Services, told the outlet, "The program was originally designed for the aged, blind, disabled, and children, and that’s who we are working to protect," and added, "The number one goal is to protect taxpayers."

Yet, other predominately Democrat-led states are expected to take their time in beginning the redetermination process, which could further stall any decisions or actual removals of enrollees from Medicaid as long as possible.

How the process will work

The Kaiser Family Foundation has compiled and published a wealth of updated information with regard to the "unwinding of the Medicaid continuous enrollment provision" that was first introduced in 2020 and resulted in the Medicaid and the separate but related Children's Health Insurance Program (CHIP) rolls increasing by more than 23.3 million new or retained enrollees to top out at nearly 95 million total.

That expansion had been incentivized by a 6.2 percent increase in federal matching funds for states, which will gradually step down over the remainder of the year for states that engage in the congressionally authorized disenrollment process in an approved manner.

How many Americans will actually now be deemed ineligible and removed from Medicaid/CHIP is unknown and estimates vary widely from as few as 5 million to as many as more than 15 million, and given the eligibility standards are slightly different in each individual state, the disenrollment will almost certainly not be equally distributed across the nation.

Further, as was noted by Politico, each state has some room to craft individual and unique plans for the 12-14-month redetermination of eligibility process within a broad framework established by the Centers for Medicare and Medicaid Services, with some states starting that process immediately in February while others have waited until April to begin.

KFF noted that many states plan to conduct much of the process administratively or "ex parte" and are simply automatically renewing enrollees whose eligibility can be determined through state databases or enrollment in other benefits programs, while other states are engaging in the process through direct contact with enrollees via mail, phone calls, in-person meetings, or even online.

Some will slip through cracks and end up uninsured

The biggest concern for some, according to KFF, is that some of the new or retained Medicaid enrollees over the past three years will soon end up uninsured as they are determined to be ineligible for Medicaid due to age or income but are also, for the same reasons, not eligible for CHIP or insurance premium subsidies under the Affordable Care Act.

That would undoubtedly be viewed as a catastrophe by Democrats like President Joe Biden, and it will be interesting to see if the White House or Congress endeavors to take any sort of executive or legislative action in an attempt to identify those individuals who may slip through cracks in the system.