Thousands have lost Medicaid as post-pandemic renewals begin in Pa., N.J.

Nearly 97,000 Pennsylvania residents have lost Medicaid coverage since April, when the state began a yearlong process of combing through a Medicaid roll that swelled during the COVID-19 pandemic.

A little more than half of them — about 54,000 people — lost coverage because their income was deemed too high to qualify for the health program intended for low-income residents. The remaining 43,000 were cut off for procedural reasons, such as failing to complete necessary paperwork.

States suspended their Medicaid renewal processes during the pandemic, which contributed to a sharp rise in the number of people covered. That’s because the regular churn of enrollees was halted, while thousands more enrolled for the first time after losing jobs.

» READ MORE: Medicaid enrollment swells during the pandemic, reaching a new high

Now, with the public health emergency over, Pennsylvania in April began the monumental task of verifying eligibility for all 3.4 million people enrolled in Medicaid.

Since then, many more people have kept their coverage than lost it:

Organizations that help people navigate Medicaid and health insurance say the process has been relatively smooth so far. Still, as states work through their backlog of Medicaid renewals in the coming months, they worry about the tens of thousands of people who may wind up without insurance because they didn’t realize they needed to take action or gave up on what can be a complicated and confusing process.

“We’ve been seeing people get cut off all over the state, many of whom still qualify,” said Jacob Hope, a Philadelphia organizer for Put People First! PA, a public health advocacy organization. “People are denied not because their income is too high, but because the paperwork requests are a lot.”

» READ MORE: Hundreds of thousands in Philadelphia region have to reapply for Medicaid. Here’s an early look at how many could be losing coverage.

Every year, people enrolled in Medicaid must complete a renewal application with documentation that shows their income, house size and employment status. Though only seven to eight pages long, the renewal application can quickly become overwhelming, Hope said.

For instance, people with multiple jobs may need to track down pay stubs from several employers or find proof of payment from jobs that pay cash. Caseworkers may request additional months of pay stubs or ask that documents be re-sent if they’re difficult to read.

Appealing a denial can be equally challenging.

“Me vs. the entire government is what it feels like,” Hope said. “People just give up.”

» READ MORE: How to avoid becoming uninsured in Pa. and N.J. with the end of the COVID public health emergency

Valerie Arkoosh, Pennsylvania’s secretary of human services and a physician, said she is also concerned about people who lose Medicaid without a clear path to private insurance and those who do not respond to the state’s outreach.

At the same time, she said, “We do have an obligation to ensure that our program is serving those who qualify, and if someone is no longer eligible, we do need to disenroll them.”

She said her department has prioritized community outreach and partnered with organizations that have strong local ties to provide enrollment help to people struggling to complete the application on their own.

And in the coming months, administrators plan to use localized data to identify neighborhoods with low response rates, and zero in on barriers, such as language and technology, she said.

The department is also working closely with Pennie, the state’s health insurance marketplace, to hand off people who are no longer eligible for Medicaid based on income.

Pennie can create an account with their Medicaid information and reach out directly to help people enroll in private insurance. Many will be eligible for a discounted health plan and may qualify for additional financial assistance.

Nick Heiman turned to Pennie when he lost Medicaid during the spring.

He signed up for Medicaid in 2021, when he aged out of his parents’ health plan and had a job that didn’t offer health benefits. The 28-year-old Conshohocken resident has since gotten a better job — still no health benefits, but a pay raise that made him ineligible for Medicaid.

Knowing he would need to change coverage, Heiman reached out to Pennsylvania Health Access Network, an organization that helps people enroll in private insurance through Pennie.

He’s now covered by a health plan with a monthly premium of about $300.

PHAN has seen a steady stream of people who, like Heiman, need help figuring out their next move, said Antoinette Kraus, the organization’s executive director.

“What we’re worried about are all the people who don’t come to us” because they’re less connected to the public safety-net system and more likely to wind up uninsured, she said. Too often, she said, people who are eligible for Medicaid don’t find out they’ve lost coverage until they go to the doctor or try to fill a prescription.

Outreach is key in New Jersey, too, where Medicaid administrators are struggling to get people to submit their renewal application.

“We are finding that too high a percentage of members in early renewal groups have not yet responded in any way to their renewal package, indicating that they may not have seen or understood the mail that was sent to them,” the department wrote in a June memo announcing that it was giving people 60 days to return their renewal application, rather than just 30.

As of June 1, New Jersey has sent renewal packets to 333,000 people and renewed coverage for 14% of them, about 45,000 people. The remaining 86% of cases are under review or pending.

Laura Waddell, health care program director of NJ Citizen Action, which advocates for health coverage and public health issues, thinks a lot of people simply aren’t aware that they will lose coverage if they don’t take action.

Many joined for the first time during the pandemic and have never gone through the state’s annual renewal process. Those who were covered before the pandemic have been out of practice for nearly four years, she said.

She thinks better communication about the deadlines — and what’s at stake if they’re not met — will help people realize “OK, this isn’t something I can leave on the kitchen table,” she said.