Red States Kicking Millions Off Medicaid, Including Kids, Because They Can

No other major country treats its children this badly. We're Number One.

2017 photo by CDC on Unsplash

In the rest of what we jokingly call the civilized world, to one degree or another, countries make sure their citizens all have access to healthcare at little or no cost to the individual, because healthcare is considered a basic right, a government function as basic as having roads and schools and a taxation system to pay for it all.

In the United States of America, nearly eight million low-income people have been kicked off Medicaid so far this year, following the end of a pandemic policy passed by Congress in 2020 that prohibited states from disenrolling Medicaid recipients during the healthcare state of emergency.

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And some states’ GOP leaders are actually proud of that: Arkansas Gov. Sarah Huckabee Sanders said in May that she considered the massive drop in healthcare coverage a real win for the state, explaining on Twitter that

“Those who do not qualify for Medicaid are taking resources from those who need them.

“But the pandemic is over - and we are leading the way back to normalcy.”

Sanders was promoting an op-ed she wrote for the Wall Street Journal in which she denied that Arkansas was “cutting” Medicaid, because really “We’re simply removing ineligible participants from the program to reserve resources for those who need them.” Too many children whooping it up on the taxpayer dime, getting wellness checks and antibiotics for strep throat. Sure, 22 percent of Arkansas kids are living at or below the poverty line, but at least they can get a job to pay for their insulin.

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Sarah Huckabee Thinks Everyone Is Way Jealous Of How 'Normal' Arkansas Is

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A September analysis by the Arkansas Times determined that Arkansas purged a greater percentage of its Medicaid recipients than any other state, often becoming undeserving poors because they didn’t return a renewal form mailed to what may or may not have been their actual address.

All told, when the state’s six-month purge of the Medicaid rolls came to an end last week, Arkansas had booted 427,000 people from their healthcare coverage because they may have been poor, but not quite poor enough, or due to bureaucratic fuckups, which are the recipients’ fault too obviously. As Arkansas Times managing editor Benjamin Hardy points out, that’s “an enormous figure for a state with a population of 3 million. Arkansas’s Medicaid enrollment as of April 1 was a little over 1 million.”

As Adam Gaffney pointed out at The Nation last week, “returning to normal” is nothing to brag about when the norm is terrible, and the pandemic’s three-year moratorium on disenrolling people from Medicaid helped illustrate exactly that:

[The] much-needed rise in participation achieved by the continuous coverage provision—enrollment rose from 71 million to 94 million from January 2020 to April 2023—was at the same time a testament to how much “churn,” or movement in-and-out of the program, occurs outside plague years when such protections are not in play. Small increases in family income can render someone ineligible for Medicaid. Moving states can provoke disenrollment. There are sometimes burdensome administrative hurdles to enrollment, which can be particularly challenging for workers with unsteady employment or income or otherwise tenuous life circumstances. Annual eligibility redeterminations can result in disenrollment if forms are not properly completed, or when they are sent by state agencies to the wrong address.

Gaffney follows that with a series of pre-pandemic stories illustrating just how common arbitrary or erroneous disenrollment can be; it’s not a “normal” anyone should find acceptable.

Our piece today was sparked by a press release from Montana Democrats calling attention to a report compiled by the state’s Health and Human Services department — at the request of Democratic legislators, not because the department felt like sharing — which revealed that of the roughly 55,000 Montanans kicked off Medicaid by Republican Gov. Greg Gianforte’s administration in the spring, nearly half were children. And like other states, the disenrollment was haphazard and led to some pretty dreadful outcomes. Gianforte’s purge was pursued by

enacting unnecessarily burdensome red tape requirements, including sending 19-page re-enrollment applications by snail mail, resulting in Montanans with life-threatening illnesses unable to get the medical care they need. Under his watch, health care access across Montana has been rolled back, including the shuttering of 20 percent of Montana nursing homes, a crippling shortage of ambulance services, and mental health systems that continue to fail Montanans.

The Biden administration has taken some steps to combat red states gleefully disenrolling their citizens. In September, the federal Centers for Medicare and Medicaid Services ordered the restoration of nearly half a million children and other recipients to Medicaid rolls because states had incorrectly declared them ineligible. And as Politico reports, CMS pledges to wield its funding power to get states to Do It Right:

Sara Lonardo, senior adviser and press secretary at CMS, said the agency is taking its monitoring and oversight role “incredibly seriously” and will continue to act to prevent eligible people from losing coverage. That can include requiring states to pause terminations, reinstate coverage, adopt strategies to help people through the renewal process and address systems issues.

“If states don’t, they will risk losing the enhanced federal funding,” Lonardo said. “Some states are coming forward proactively to CMS to acknowledge and fix renewal issues.”

That Politico story also notes, though, that the administration has “refused to publicly criticize individual states or even identify which ones it believes face the most serious issues, for fear of damaging its relationships with them.” Because heaven knows, that’ll prevent crankiness among people who think Biden is a socialist tyrant dictator who hates America so much that he sometimes pets dogs and eats ice cream with union workers.

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That quiet approach has led some congressional Democrats to call for the administration to get tougher on states that are arbitrarily tossing people from coverage, and yes please, that would be good. And for Crom’s sake, if states aren’t letting people know their coverage options after they lose Medicaid, CMS needs to both crack down and to blanket those states with public service announcements to get them into Obamacare or other options.

Oh yeah, and how about real universal healthcare? That seems like a good idea to run on, said the eternally disappointed optimist.

[PBS Newshour / Montana Democrats / The Nation / Arkansas Times / KFF Medicaid Tracker / WaPo gift link / The Hill / Politico]

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