On March 31, 2023, the federal government declared the COVID public health emergency over. That created another national health emergency. It was called the Medicaid “Unwinding”— a massive “disenrollment.”

During COVID, the federal government put in place protections to prohibit the termination of people on Medicaid — until the emergency ended. On April 1, 2023, Medicaid’s “continuous coverage” protections stopped. Redeterminations began, and lasted through May 2024. The feds paid states a bonus to redetermine every Medicaid member.

According to the Kaiser Family Foundation (KFF), an estimated 23.8 million people nationwide were disenrolled from Medicaid by the end of June 2024. That disenrollment equals the total population of America’s top eight cities: New York, Los Angeles, Chicago, Houston, Phoenix, Philadelphia, San Antonio and Dallas. Sixty-nine percent of those terminated were because of “procedural reasons,” mostly “incomplete applications.”

At the start of “unwinding” in April of 2023, Massachusetts Medicaid (MassHealth) had around 2.401 million members. By the end of redeterminations in May 2024, the caseload dropped to 2.039 million — a loss of 362,500 enrollees. Around two-thirds of these disenrollments were caused by “insufficient information.” Members who never responded to MassHealth letters were deleted. MassHealth says it “engaged in extensive outreach efforts that were unprecedented in nature.” They knocked on 428,000 doors in 15 communities. Yet 242,875 people in the commonwealth lost their MassHealth insurance because they never finished their application.

One of the people who almost lost his health coverage was my elderly friend from Montague who I will call Ryan. In April 2024, he received a letter from the state Office of Medicaid. The letter told Ryan: “We need more information before we can make a final decision about your eligibility for health-care benefits.” If Ryan did not send in “all the information we need by July 24 … your health care benefits may be denied.”

On May 30, Ryan received another letter, this one from Social Security: “The State of Massachusetts will no longer pay your Medicare Part B medical insurance premiums after May 2024. You must pay the premiums starting June 2024.” Ryan’s Social Security check would be cut $174.70 each month, leaving him with $1,154 a month beginning May 2024. Ryan would have $37.94 a day to pay all his living expenses: food, homeowner’s insurance, property taxes, state and federal taxes, etc.

A week later, Ryan received a letter from Community Action of Pioneer Valley explaining that he needed to submit his IRS interest and dividend income data by July 15, or he would be denied his fuel assistance benefits for 2024.

Ryan is 77 years old. He has a chronic disease that affects his cognition and his physical stamina. He handed me his stack of bad news letters: “What do these letters mean?” he asked. “They’re cutting off your Medicaid on July 24th,” I said. “Social Security is reducing your monthly check. Your fuel assistance application is incomplete, and will be denied by July 15th.”

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We began a marathon collection process for Ryan’s verifications: savings, checking and IRA bank balances; mutual fund balances over the past 36 months; his most recent IRS 1040 form. We got great assistance from Baystate Franklin’s Financial Services Department in submitting all these income and asset verifications to MassHealth.

In the end, Ryan was approved by MassHealth for CommonHealth, which is the equivalent of MassHealth Standard, starting June 1. This restored thousands of dollars in his health care coverage. He will also get “Senior Buy In” starting July 1, which means MassHealth will pay for Ryan’s Medicare Part B premiums, replenishing $1,048 to his Social Security check over the next six months. Ryan also got a fuel assistance grant of nearly $1,000 from Community Action.

MassHealth is now providing “targeted support to seniors, including launching a simplified renewal form for most members, offering renewals online or over the phone.” Unfortunately, the state notes that “moving forward, all members will need to undergo an annual redetermination or eligibility review, on a yearly basis.” Ryan will have to be redetermined again next year.

Medicaid should provide “continuous coverage” for people like Ryan, whose health and income change little. The state should improve its data collection capacity for member documents like income and asset records rather than requiring elderly and disabled applicants to track their missing information.

Millions of Americans have lost their health coverage because of the convoluted data collection requirements. Call 1-617-722-2000, and ask your state legislators to “improve the Medicaid verification process instead of dumping a lot of paperwork on elderly, children’s parents, and the disabled.”

Al Norman’s Pushback column appears twice a month on Wednesdays in the Recorder.