Study finds people of color disproportionately dropped from Medicaid

The COVID-19 pandemic dramatically improved health insurance coverage for millions of Americans who were automatically covered by Medicaid due to the national public health emergency.

With the end of the emergency in April 2023, about 10 million people lost coverage as states began redetermining eligibility. However, an estimated three-quarters of disenrollments occurred not because states decided they were ineligible, but rather due to procedural reasons. These process-related issues could include enrollees not receiving renewal notices, not filling out the correct paperwork, or not completing all the steps needed for Medicaid redetermination.

New research suggests Black and Hispanic people were twice as likely as white people to lose Medicaid coverage due to process-related issues, report findings published today in the journal JAMA Internal Medicine by researchers at Oregon Health & Science University, Northwestern University and Harvard Medical School.

“A lot of people got kicked off Medicaid for administrative reasons,” said senior author Jane Zhu, M.D., associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. “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.”

Researchers noted that state-level information on causes of procedural disenrollments is limited, and that only nine states currently report disenrollments by race and ethnicity.

So they used publicly available data from the U.S. Census Bureau’s Household Pulse Survey between March 29 and Oct. 2, 2023, to estimate adult Medicaid disenrollment by race and ethnicity during the Medicaid unwinding period. They found that individuals who identified as Black and Hispanic were twice as likely as white people to report losing Medicaid coverage due to inability to complete the renewal process.

Researchers called for policymakers to improve Medicaid enrollment processes in order to reduce health disparities.

“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 write.

In addition to Zhu, co-authors include Kranti C. Rumalla of Northwestern University, Daniel B. Nelson, M.D., of Harvard Medical School, and John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness.