The Medicaid unwinding: Some 31% of renewals processed so far have resulted in lost coverage

COVID-19 saw many habits upended; enrollment in Medicaid was no exception

Pittsburgh Post-Gazette

JUN 15, 2023 9:54 AM

Tammy Rojas was “stressed out of my mind.” They had one week to
complete their Medicaid renewal, and technology was not on their side.
“I was stressing and scrambling to get the stuff done,” the Lancaster
resident, 46, said. “I went on the website, but the part to file renewals
wasn’t working. … I thought to myself, ‘You’ve got to be kidding me.’”

Mx. Rojas, who works at a shelter for people experiencing homelessness,
is one of millions of Pennsylvanians once again navigating the Medicaid
reenrollment process.

In regular times, reupping is an annual ritual, like filing taxes. But
COVID-19 saw many habits upended, and enrollment in Medicaid,
known as Medical Assistance in the Commonwealth, was no exception:
Under the Consolidated Appropriations Act, millions of Americans were
afforded continuous coverage, so they were automatically reenrolled in
the free medical insurance.

Those pandemic-era protections ended on March 31, leaving the more
than 93 million people enrolled in Medicaid and CHIP nationwide, as of
February, with the task of determining their renewal dates and filing by
their individual deadlines.

The number of Medicaid recipients coming out of the pandemic is
unprecedented, as is the process of “unwinding,” or shifting such a mass
of people from a three-year pause back to the rhythms of an annual
enrollment cycle.

Mx. Rojas, a volunteer with health care activist group Put People First!
PA, was reenrolled — “I got lucky” — but not everyone will be. Or has

The Biden administration sent up a flare on Monday, concerned about
the large number of Americans who have already been disenrolled for
largely administrative reasons, such as not having a current address on

“I am deeply concerned with the number of people unnecessarily losing
coverage, especially those who appear to have lost coverage for avoidable
reasons that State Medicaid offices have the power to prevent or
mitigate,” Health and Human Services secretary Xavier Becerra said in a
June 12 letter to governors.

More than 1 million have lost coverage
Approximately 31% of renewals processed so far have resulted in a loss of
Medicaid or CHIP coverage, per the Centers for Medicare & Medicaid

CMS, through a spokesperson, declined to offer the actual number of
people cut off, though the Kaiser Family Foundation, which maintains a
Medicaid Enrollment and Unwinding Tracker, counts more than 1
million people who have lost coverage, based on data reported by 21

In Pennsylvania, the hard number is 15,560, per DHS’s most recent
report in mid-May. They “have been determined to be ineligible for
Medicaid, either because of information in their renewal or because they
did not return a renewal,” a DHS spokesperson said in an email.
While states are in charge of their Medicaid programs, including the
logistics of the reenrollment process, they self-report data to HHS. That
process makes for a lag in numbers being publicly reported, so it’s
difficult to have a crystal clear sense of the actual scope of those being

Mr. Becerra reminded governors of so-called flexibilities offered to each
state throughout the reenrollment process. For example, most states,
including Pennsylvania, have chosen to spread the undertaking across 12

HHS also announced an expanded list of flexibilities, which now includes
a suggestion to reenroll someone “if able to do so based on available

While those new options are currently being reviewed by the state, a DHS
spokesperson said, the original list had been discussed “fairly
extensively.” And some recommendations, such as renewing people
based on eligibility for other programs, such as SNAP, are already part of DHS’s approach.

“DHS has similar processes in place already because Pennsylvania
currently aligns case processing as much as possible for households
participating in multiple programs,” the spokesperson said.

With DHS data reported through mid-May, more than 1.3 million people
make up the “total maintained population,” which consists of 1,245,424
individuals who have yet to complete a renewal and 77,129 who have.
Pre-pandemic, some 17 million people had their Medicaid or CHIP
coverage terminated every year, per a CMS spokesperson, “some because
they’re no longer eligible, but others because of red tape.” Multiply that
number by three (years), and the country is looking at, potentially, more
than 50 million terminations.

Awareness efforts crucial to renewal process
A huge component of the reenrollment process is education, and not
merely in terms of the administrative how-tos. A large swath of Medicaid
recipients don’t even know the unwinding is occurring.

“A recent survey of Medicaid enrollees found that two-thirds of people
were not sure if their state was returning to regular Medicaid
operations,” Mr. Becerra stated in his letter.

Awareness efforts have been baked into the unwinding, including
advertisements put out both by the state and CMS. A DHS spokesperson
said Pennsylvania had been planning for the return to annual
reenrollment of Medical Assistance and CHIP for more than a year.

The state’s DHS, the spokesperson said, “continued to send annual
renewal packages to Medicaid recipients throughout the pandemic, even
though no action would be taken on their coverage if they were no longer
eligible or if they did not return their renewal.”

But the obstacles for reaching those most vulnerable are many. Children
enrolled in CHIP are of particular concern, as are people without stable
home addresses.

“We are really focusing on folks with language barriers, also folks who
don’t have access to online capabilities, and those who aren’t receiving
their mail … and those who truly don’t know they’re up for renewals,”
said Tia Whitaker, statewide director of outreach and enrollment with
Pennsylvania Association of Community Health Centers.

Creative outreach solutions are threaded through the federally suggested
flexibilities, and they’re also being employed by community-level groups.
One such organization takes the meet-people-where-they-are approach
by educating folks about health care in laundromats.

Fabric Health first came to Pittsburgh in December, per co-founder
Allister Chang, after launching in Philadelphia earlier in 2022.
Representatives with the nonprofit can be found in five laundromats in
the Pittsburgh area.

Though Fabric Health helps clients with an array of health care issues,
the Medicaid unwinding has been a priority.

“We’ve been doing a lot of education and outreach around this because a
lot of Medicaid recipients don’t know quite what’s happening,” said
Jacob Hope, a health policy specialist with Fabric Health.

“There are plenty of people it is actually a big issue for,” Mr. Hope said,
citing individuals who have fluctuating incomes and/or move often. “You
have to send pay stubs, you have to send in this packet. … There are a lot
of administrative hurdles or burdens on people. That’s common.”
‘I wasn’t sure what I would do’

For Gary Rush, of Dormont, the first hurdle was a letter he said he
received stating he was going to lose his coverage.

“I must of gotten a letter on a Saturday. I didn’t open it up until Monday
night. It said I was going to lose my health coverage on April 20, which
was only a few days away,” Mr. Rush, 67, said.

Enrolled in Medicaid since before the pandemic, Mr. Rush, who is dual-
eligible for Medicare, wasn’t entirely clear why he was denied coverage.

“I guess it was one of my retirement funds,” he said of modest savings
including a 401K. He’s been on disability, he said, due to chronic back
pain that required surgery about five years ago and diabetes.
Encouraged by his mother to reach out to Put People First! PA, Mr. Rush
connected with the grassroots organization for assistance with filing an

With that all-volunteer group’s help, “In one day we were able to file the
appeal. I wasn’t sure what I would do for health coverage,” Mr. Rush

Mr. Rush joined about 30 people at a Put People First! rally outside the
state Capitol Building in Harrisburg on June 7, condensing his Medicaid
story into a minute as he told those gathered of his many health
challenges and the crushing math of his medication (one costs nearly
$700) and social security income that doesn’t inch far past.

In addition to demonstrations — the Harrisburg event was dubbed
“Caroling the Crisis” — the group has spread Medicaid renewal news in
myriad ways, from old-fashioned door knocking to a #MedicaidMondays
social media campaign that encourages people to share the importance of
the insurance to them.

An option at the heart of the group’s message would remove the need for
reenrollment entirely: Medicaid coverage for all.

Mr. Hope, also a volunteer with Put People First!, has been assisting Mr. Rush with his appeal.

As he awaits the verdict, Mr. Rush’s Medicaid has remained in place.

‘We have a range of oversight levers’
Adding to the challenges on the enrollee’s part is mere bandwidth on the
administrative end.

“Honestly, it’s a capacity issue,” said Antoinette Kraus, executive director
of nonprofit Pennsylvania Health Access, a Philadelphia-based health
care advocacy group, “because there are so many people who have to go
through Medicaid renewal.”

That stretching of resources, Ms. Kraus said, has manifested in long wait
times at call centers.

“We just encourage people not to give up,” she said, adding that, if
someone’s not sure about their status, a good starting point is the state
helpline, 800-692-7462. Medicaid recipients can check their renewal
dates at as well.

Ms. Kraus noted that, in the weeks leading up to the end of continuous
enrollment, PHAN had seen “a definite uptick” in calls for help with the
renewal process.

DHS said its “call center operations are strong,” with average wait times
at five minutes in April, the latest month data is available for.
In his letter to governors, Mr. Becerra reminded states of HHS’s
regulatory prowess should they be noncompliant with federal
regulations, “and individuals must be afforded the due process to which
they are entitled in order for states to continue to receive enhanced
federal funding.”

“We have a range of oversight levers,” explained Dan Tsai, director of the
Center for Medicaid and CHIP Services, in a press call on Tuesday.

Center for Medicaid and CHIP Services, in a press call on Tuesday.
Should a state not follow the rules, he noted, Mr. Becerra has the
authority to place that state under a corrective action plan.
Polly Higgins:
First Published June 15, 2023, 8:48am

The Southwest PA Healthcare Rights Committee of Put People First! PA held our first Medicaid Cut Off Appeal Action on Thursday, June 15th for Gary Rush. Here is media coverage.

90K Pennsylvanians have lost Medicaid coverage since the end of pandemic-era rule

90.5 WESA By Kate Giammarise

Since the end of a pandemic-era policy, roughly 20% of Pennsylvanians who had to renew their Medical Assistance coverage have lost it, according to data the state shares with the federal government.

Slightly more than half of those people lost the health insurance coverage because they were no longer eligible, likely because their income was too high to remain in the program. But just under half — more than 40,000 people — were removed from the program for procedural reasons: failure to return paperwork, a problem many advocates have been warning about.

Some who were ineligible for the program have found other coverage through the state’s health insurance marketplace, Pennie. It’s unclear how many children who lost coverage were able to enroll in CHIP, the state’s Children’s Health Insurance Program.

Many of the renewals undertaken in the last two months — more than 100,000 — are still incomplete, so it’s unclear how many people will ultimately lose coverage.

Still, state officials say, while it is early in what will be a year-long process, they aren’t seeing the processing backlogs some had feared.

“I’m pretty pleased with our progress to date,” said Hoa Pham, deputy secretary for the Pennsylvania Department of Human Services Office of Income Maintenance, though she noted “it’s early days.”

Some health care advocates also cautioned it was too early in the process to draw any firm conclusions.

“We’re only two months into a yearlong process, with a lot of folks that still need to be determined,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network.

During the COVID-19 pandemic, people could remain enrolled in Medicaid without having to complete re-enrollment paperwork that normally must be completed every 12 months. Enrollment in the health care program grew considerably during the time; more than 800,000 Pennsylvanians got and stayed enrolled in the program, also known as Medical Assistance. Enrollment swelled to roughly 3.7 million people. But that pandemic-era policy ended April 1, and the state now is in the midst of what many fear will be a burdensome bureaucratic process.

Nationally, more than one million people have been disenrolled in Medicaid since the end of March, according to health policy website KFF, and the Biden administration expressed concern to states earlier this month too many people were losing coverage because of red tape.

One of those at risk of losing his coverage is Allegheny County resident Gary Rush, 67.

He lives on Social Security and a small pension; he’s been told he will no longer qualify for Medicaid because of about $70,000 in retirement savings. He says he doesn’t know what he will do without the coverage; he has diabetes, arthritis, and several other health conditions. He also has Medicare coverage, though noted that was much more costly.

“What am I supposed to do?” Rush asked.

He spoke at an event in Pittsburgh earlier this month with advocacy group Put People First! PA.

Other advocates have also said they are concerned with the number of people who will likely lose coverage.

There’s a “strong likelihood” that the children who lost coverage for procedural reasons are still Medicaid-eligible, according to advocacy organization Pennsylvania Partnerships for Children.

For those individuals whose income is now too high for the program, Pennsylvania officials have said they are striving to connect those people withPennie, the state Affordable Care Act exchange that allows people to purchase insurance plans. More than 3,000 people were successfully connected to coverage through Pennie in April, Pham said.

Last weekend all five of Put People First! PA’s Healthcare Rights Committees (HRC) were out in our communities taking action. In Southwest PA, the HRC took action for our first Medicaid Cut Off Appeal. In Northeast PA, the HRC hosted a People’s Clinic. In Central Appalachia, members knocked doors. In South Central, members tabled at a community event. In Southeast PA, the HRC held an art build for future actions! Check out the photo report back below for more.

Southwest PA (SWPA)
Members of the Southwest PA Healthcare Rights Committee (HRC) gathered outside where the Department of Human Services Bureau of Hearings and Appeals regional office is located, to call attention to the injustice faced by Gary Rush, whose life-saving Medicaid was cut off. Gary’s Medicaid was extended for another three weeks, but he’ll have to continue to fight to keep his Medicaid. Two days later, SWPA members Julia, Barbara, and Rica tabled in Jeanette, PA for some base building!
South Central PA (SCPA) Members of the South Central PA HRC tabled at a community health and safety event to do some base building!
Southeast PAMembers of the Southeast PA HRC held an art building event in Delaware County, making posters, banners, and art to use in future actions! There was also a screening of a documentary about friends of PPF-PA, David and Janet Greene: Revolutionary Hearts (2023). 
Central Appalachia PA (CAPA) Members of the Central Appalachia PA HRC recently held a successful door-knocking, making promising contacts with members of their local community
Northeast PA (NEPA) Members of the Northeast PA HRC recently held a People’s Clinic in Berwick, PA, where the local community has been devastated by the fact that their local hospital closed its doors, leaving them twenty minutes from the closest ER.
“Our People’s Clinics certainly can’t replace a hospital but, as Projects of Survival, they can educate folks on how to get ORGANIZED to combat these deep systemic healthcare issues,” said a member of NEPA.

For Immediate Release: June 12th, 2023


Barbara White | | 412-381-6886

Put People First! PA  |


: Pittsburgh residents, Southwest Pennsylvania Healthcare Rights Committee of Put People First! PA, members of the Nonviolent Medicaid Army
What: Support Rally outside Gateway 2, location of the Department of Human Services Bureau of Hearings and Appeals 

Photo/Video Opportunities: Public demonstration, signs, testimony from affected residents

When: Thursday, June 15th, 12:30PM 

Where: Gateway 2, Corner of Penn and Stanwix

Pittsburgh residents and members of Put People First! PA will gather outside Gateway 2 on Thursday, where the Department of Human Services Bureau of Hearings and Appeals regional office is located, to call attention to the injustice faced by senior Gary Rush and the thousands of other Pittsburgh residents who are losing their Medicaid and their healthcare. As the bipartisan decision by Congress in December 2022 to end the continuous coverage requirement for Medicaid take effect, we demand that the Department of Health and Human Services Bureau of Hearing and Appeals grant Mr. Rush’s appeal and maintain his Medicaid enrollment.

Mr. Rush qualified for Medicaid after becoming disabled, and is receiving treatment for his diabetes, chronic back pain, and kidney disease. Being insured allowed him to do something that many seniors aspire to – he put away a little money for retirement.

But thanks to the draconian rules reimposed by the end of the continuous coverage requirement for Medicaid, which are on track to revoke benefits from over 1 million poor and working-class Pennsylvania residents, Gary Rush has, like many Pennsylvanians, received notice that he no longer qualifies for the healthcare he relies on to survive.

Medicaid, like other public benefits, is a harsh system where you regularly have to prove you deserve assistance by staying under income limits. If you make $1 over the limit, you are thrown off the rolls and you lose your healthcare. For some, these limits also extend to your retirement savings – effectively prohibiting any senior on Medicaid from putting aside money for medical treatment or end of life care.

Without his Medicaid and prescription coverage, Gary would be forced to spend the majority of his monthly Social Security income on his healthcare. Gary’s medications, for example, total anywhere from $700-$800/month without insurance. On top of that, without Medicaid, he would have to start paying out of pocket costs for his primary care visits, specialist visits, lab work, and more.

“I don’t know how I am going to pay for everything if I don’t have Medicaid”, said Gary Rush. “I am on a fixed income which meets my living expenses, but without the Medicaid I might have to stop some of my care or start eating into my savings or retirement accounts to stay healthy. I have doctors and specialists that I see and without Medicaid, I don’t even know how much that would cost.”

It is for this reason that a group of Pittsburgh residents, led by the Southwest Pennsylvania Healthcare Rights Committee of Put People First! PA, will gather near Gateway 2, outside the Department of Health and Human Services Bureau of Hearing and Appeals, to advocate for Mr. Rush’s fair treatment, and to insist that his Medicaid coverage be maintained.

Responding to the situation in which Mr. Rush and many other PA residents find themselves, Put People First! PA is demanding that no one lose their healthcare; that PA should instead invest some of the $8 billion dollar budget surplus to expand Medicaid to cover all PA residents, fully restore the Medicaid Adult Dental Benefit that was cut in 2011, and that the legislature should pass a bill to establish an office of the Public Healthcare Advocate [1] for Pennsylvania to provide support for residents like Mr. Rush fighting for their healthcare rights.

For more information on the Public Healthcare Advocate (2021-2022 House Session HB1828), see the policy report released by Put People First! PA in August 2021.