7 million Americans lose Medicaid coverage

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It’s Saturday, Sept. 23, and we’d like to welcome you to the weekly State and Local Roundup. There’s plenty to keep tabs on, with Mainers set to vote on whether to keep their two biggest utilities, Miami City Hall awash in scandal, Pennsylvania adopting automatic voter registration and bail reforms going into effect in Illinois. 

But first, we take a look at significant developments in state efforts to end pandemic-era Medicaid policies that allowed millions of Americans to get public health insurance for three years without routine checks into their eligibility. This week, KFF, formerly the Kaiser Family Foundation, reported that nearly 7.2 million people have lost coverage as a result.

Medicaid is the biggest health insurance program—public or private—in the country. As of the end of last year, it covered more than 92 million low-income Americans and people in other vulnerable groups. It is jointly run by and paid for by the federal government and individual states.

States began the process of reverifying the eligibility of Medicaid recipients in April, and under federal law, they have one year to complete the process. But states have taken different approaches to the task. Some moved quickly to pare the rolls, often by prioritizing checks of enrollees that they suspect no longer qualify for the program. Other states are simply verifying recipients as their regularly scheduled renewal dates come up.

As a result, there have been large differences among states in how many Medicaid recipients have been disenrolled, according to KFF. Texas leads the pack, with 888,000 people losing coverage. Next is Florida, with 700,000 recipients removed from the program. And Arkansas ranks third, with nearly 374,000 people off the rolls.

States also differ greatly in the rate of people they contacted that have been removed. In Texas, 69% of recipients the state reached out to were taken off the program, the highest rate of any state. In Maine and Oregon, though, that rate was just 14%, the lowest in the country.

Nearly three-quarters of people across the country that have lost coverage were removed for procedural reasons, such as not filling out required paperwork on time. The rest were found ineligible for substantive reasons, like exceeding the income thresholds for the program.

The level of detail available to researchers and the public about how Medicaid disenrollments are handled is new. Congress included new reporting requirements for states in a budget bill it passed last year. States have to provide details about the disenrollment process in order to receive a higher reimbursement rate from the federal government.

The extra scrutiny on the Medicaid “unwinding” process has helped the federal government and researchers get more insight into long-standing problems, said Bradley Corallo, a senior policy analyst for KFF. “We are identifying a lot of problems and fixing them, so renewals can run smoother in the future. That has been a problem for Medicaid in the past, with people losing coverage at renewal, and churning back onto the program off and on. Hopefully some good comes out of it.”

Individual states might have had information about their own programs, Corallo said, but information about disenrollments hadn’t previously been available nationally or in a standardized way.

Already, the federal Centers for Medicare & Medicaid Services have flagged a problem that caused states to improperly remove eligible people from Medicaid. This week, the agency announced that 30 states had been wrongly processing automatic renewals. Those states have since reinstated nearly half a million people—mostly children—to Medicaid.

Nevada and Pennsylvania both found more than 100,000 people in their states were incorrectly taken off the program as a result of the problem.

“We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid or CHIP coverage from being disenrolled,” said Xavier Becerra, the secretary for the U.S. Department of Health and Human Services.

It’s unclear how many people will lose Medicaid coverage by the end of the unwinding process. A strong economy could help recipients find jobs and enroll in private health insurance, rather than Medicaid. And staying on the program could be easier in some states than others. But KFF estimated in April that anywhere between 8 million and 24 million people could end up losing Medicaid insurance.

Corallo noted that the federal government is focusing on helping people keep their health insurance, whether through Medicaid or other providers. The Biden administration has offered several waivers for states to help the renewal process run more smoothly, he said, and dealt with the glitch that CMS flagged with automated reenrollments quickly.

“No one’s happy to see an issue but they are happy to see that CMS and states have been quick to admit the problem, reinstate coverage and start working on fixing it,” he said. “That's good news.”

Keep reading as there’s more news to use below, and make sure to come back here for the week’s highlights. If you don’t already and would prefer to get it in your inbox, you can subscribe to this newsletter here. We’ll see you next week.

News to Use

Trends, Common Challenges, Cool Ideas, FYIs and Notable Events

• PUBLIC UTILITIES: Will Mainers vote their two biggest utilities out? On Nov. 7, residents will decide whether to initiate a public takeover of the state’s two investor-owned utilities, which together service more than 96% of Maine’s electric demand. The ballot initiative, called Question 3, would create a new nonprofit company to purchase the electric transmission and distribution systems currently operated by the for-profit utilities, which have been plagued by poor reliability rankings, blasted for high prices and are bottom of the barrel for customer satisfaction. Utility experts and public power advocates are watching, as there is broad agreement that nothing like it has been seen at the state level since Nebraska began absorbing investor-owned utilities into public power districts in the 1930s and 1940s.


• CORRUPTION: Half of Miami’s elected officials are under investigation. Now-suspended Commissioner Alex Díaz de la Portilla is facing criminal charges that he sold his vote for $245,000 in campaign cash. At the same time, the FBI is separately investigating whether Mayor Francis Suarez worked behind the scenes to help a developer who was quietly paying him $10,000 a month. And local prosecutors have an open case prompted by old accusations that several of the city’s politicians—in particular Commissioner and former Mayor Joe Carollo—held improper influence over the police force. All three men have denied wrongdoing.


• VOTING: Pennsylvania to enact automatic voter registration. Gov. Josh Shapiro kicked off National Voter Registration Day on Tuesday with a surprise announcement: Pennsylvania will now have automatic registration for eligible voters when they renew or receive their driver’s license or ID. Under the measure, residents have to provide proof of identity, residency, age and citizenship when renewing their licenses—the typical personal information required to register to vote. According to the National Conference of State Legislatures, 23 states and Washington, D.C. have enacted or implemented automatic voter registration.


• BAIL REFORM: New bail reforms go into effect in Illinois. The state’s historic bail reforms that eliminates cash bail as a condition of release from jail went into effect this week, after a nine-month delay due to litigation from prosecutors across the state who opposed the law. Though a number of jurisdictions have eliminated or reduced cash bail in some form, Illinois is the first state to fully eliminate it legislatively. Proponents of the law have long argued that cash bail deepens disparities in the system by disproportionately jailing people too poor to make bail, though some progressive advocates are citing concern about the law leading to an overreliance on electronic monitoring.


• GUN VIOLENCE: Biden administration to create gun violence prevention office. The White House on Thursday announced a new Office of Gun Violence Prevention that will focus on helping states and localities implement federal gun safety legislation that President Joe Biden signed into law last year. The law, among other things, provides $750 million to help states enact "red flag laws," which allow courts to order the temporary confiscation of firearms from someone considered to be a threat to themselves or others.


• ENVIRONMENT: Massachusetts will stop buying plastic, governor says. Gov. Maura Healey made the announcement on Monday, saying “I will sign an executive order that bans the purchase of single-use plastics by state agencies in Massachusetts.” According to Healey, her order will make Massachusetts the first of 50 state governments to stop purchasing single-use plastic bottles officially. The order will be effective immediately upon issue.


• ZONING: What the defeat of Minneapolis 2040 means for land use reform. By halting the implementation of a land-use plan hailed by sustainable transportation advocates as one of the most forward-thinking zoning codes in America, reported Streetsblog, a Minnesota judge has stoked fears that environmental laws in other states will be deployed to defeat policies that reduce how much we drive. Last week, a district court ruled that local officials could no longer enforce the so-called Minneapolis 2040 plan, which aimed to increase the housing supply and decrease car dependency in the city. The plan had made the Minnesota metropolis the largest in the nation to eliminate parking minimums, as well as end single-family zoning. Minneapolis officials have said they will appeal. Meanwhile, New York City has unveiled a massive overhaul of its long-standing zoning regulations, including allowing conversions of empty houses, allowing more accessory dwelling units, and ending rules requiring parking. 


• SOCIAL MEDIA: Judge blocks California’s child online safety law. A federal judge on Monday temporarily blocked an online child protection law in California and said it probably violates the First Amendment. Under the law, digital platforms would have to vet their products before public release to see whether those offerings could harm kids and teens. The law also requires platforms to enable stronger data privacy protections by default for younger users. The initial ruling dealt a massive blow to state lawmakers, who passed the law with broad bipartisan support last year, and to children’s safety advocates, who touted the measure as one of the strongest children’s online safety laws in the U.S. Lawmakers in several other states have since pushed to replicate the standards.


• HIGHER EDUCATION: Despite public outcry, WVU will cut 28 majors, 143 faculty jobs. West Virginia University will move forward with the cuts to its flagship Morgantown campus, following a vote from the Board of Governors late last week. The decision is the board’s effort to deal with the university’s $45 million deficit largely driven by declining enrollment and declining state support. Students unsuccessfully pleaded with university leaders to reconsider the changes, which have faced national scrutiny—particularly as the university will no longer offer graduate degrees in mathematics.


• EDUCATION: Oregon takes another look at “equity grading.” State education officials are quietly reviving a reform-minded method of grading focused on how well students master specific academic skills while de-emphasizing other traditional measures, like turning in assignments on time, behaving well in class and completing extra credit. The approach, known as proficiency-based or equitable grading, had a heyday in Oregon in the early 2010s, but by 2014 was optional after pushback was swift and intense, with school districts seeking more autonomy. Now, following the pandemic when failure rates hit an all-time high, The concept is again gaining traction in Oregon as statewide assessment tests show that most students have not regained ground in key subjects following the COVID pandemic.


• PUBLIC HEALTH: Michigan lawmakers OK universal lead screening for young children. Physicians would generally be required to test or order testing for lead poisoning for all young children in the state under legislation heading to Gov. Gretchen Whitmer for her expected signature. Supporters say the legislation is an important attempt to boost detection and mitigation of lead poisoning in Michigan, which in 2021 ranked third-highest in the nation for the percentage of children with elevated lead levels in their blood. Lead exposure can result in developmental issues, brain and nervous system damage, learning and behavioral problems, slow growth and hearing or speech problems. At least 10 states already have universal lead screening policies of some kind, according to a 2017 report by the Safer Chemicals, Healthy Families nonprofit.

Picture of the Week

Almost 25 years ago, a coalition of local environmental groups filed a lawsuit against DC Water for allowing billions of gallons of untreated sewage to spill into the rivers around Washington, D.C., reported DCist this week. Now, work is complete on a massive system of tunnels that will prevent 98% of sewer overflows into the Anacostia River—a major step in the ongoing restoration of the river. As of late last week, DC Water put in service the system’s final segment, the Northeast Boundary Tunnel, connecting it with an earlier phase of the project that went online in 2018. With the new tunnel in operation, overflows are expected to happen only twice a year now, resulting in a dramatic improvement in water quality. Already, the first phase of the project has kept 15 billion gallons of untreated sewage and stormwater out of the river, along with 9,800 tons of trash. DC Water will now turn to building similar tunnels for the Potomac River and Rock Creek tributary, to be completed by 2030. The entire project is slated to cost $2.7 billion, much of it paid for by DC Water customers through a charge on monthly water bills. (Photos courtesy of DC Water)

Government in Numbers

38 million

The pounds of garbage and other debris strewn across roads, rest areas and public lands last year in Washington state, according to a new Department of Ecology-commissioned study. That’s nearly 5 pounds per resident annually. More than 8,000 pieces of trash, including cigarette butts, food wrappers, snack bags and glass bottles, peppered each mile of the state’s roadways last spring. That’s well above a national average of about 5,700 pieces per mile presented in a different report, the Washington State Standard reported. “It’s heartbreaking to see the most beautiful state in the country marred by litter,” Gov. Jay Inslee said in a statement.