Medicaid grew greatly during the pandemic. Soon it will shrink again. :shots


George Mink Jr. is a health care outreach worker in Delaware County, Pa. They worry about what will happen when the vaccines aren’t paid for by the federal government. (Kimberly Poynter / Why)

Kimberly Poynter / Why


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George Mink Jr. is a health care outreach worker in Delaware County, Pa. They worry about what will happen when the vaccines aren’t paid for by the federal government. (Kimberly Poynter / Why)

Kimberly Poynter / Why

Robert, who lives in Philadelphia, knows that signing up for Medicaid can be difficult with his ADHD, so he brought his daughter along to help fill out the paperwork.

“If we miss one little detail, they’ll reject you,” says Robert, who has had government health insurance for low-income people in the past. “I usually get two applications, so if I mess up on one. I can do another.”

This time, with the help of his daughter, the application took Robert only half an hour. (NPR agreed to use Robert’s first name only because he has a medical condition he wants to keep private.)

After a three-year break from the hassles of paperwork, signing up for Medicaid the right way is about to become an important step again for enrollees. In 2020, the federal government recognized that a pandemic would be a bad time for people to lose access to medical care, so it required states to keep people on Medicaid as long as the country was in a public health emergency. The pandemic continues and so does the public health emergency, which was recently renewed on January 11.

But a special Medicaid measure known as “continuing enrollment” will expire on March 31, 2023, no matter what. It was part of the budget bill that Congress passed in December 2022. Even if the public health emergency is renewed in April, states will start re-signing people up on Medicaid to renew their coverage. And that means 5 to 14 million Americans could lose their Medicaid coverage, according to the Kaiser Family Foundation, a nonpartisan health policy organization.

The federal Department of Health and Human Services expects 6.8 million people, based on historical trends, to lose their coverage even though they are still eligible, given the paperwork and other administrative hurdles. Before the pandemic, some states made it very difficult for people to sign up for and re-enroll in Medicaid to keep them off the list.

Over the three pandemic years, the number of Americans on Medicaid and CHIP — the Children’s Health Insurance Program — rose to 90.9 million, an increase of nearly 20 million.

Jen Lydick is director of social services and community engagement at the Public Health Management Corporation, a nonprofit that runs six health centers in Philadelphia. She says that the relief from renewal paperwork “allowed for a continuity that I think has been really lifesaving for a lot of people.”

“I know so many patients who are now able to really get ahead of their health conditions,” says Lidick.

Research shows that disruptions in Medicaid coverage can lead to delayed care, reduced preventive care, and higher health care costs associated with not managing chronic conditions such as diabetes and substance-use disorders.

Philadelphia Health Commissioner Cheryl Bettigole worked at the city’s health centers for years. He said pandemic measures such as continued Medicaid enrollment and free access to COVID-19 tests and treatments have been a major progress. She would like to see some of that last one.

“It was this moment with the pandemic in which we recognized that access to care is really important for everybody. And we’ve somehow changed our mind about that,” says Bettigoole. “If we have a new, better vaccine that lasts longer, we want everyone to get it. We identified it for one moment, for one situation, and now we’re backing away from it. I think that’s a pity.”

The increased Medicaid roll means the country has a historically high rate of uninsured people at 92%. This rate is likely to go down as Medicaid is scaled down again. States have some discretion about when to redo the sign up process. This may take a few months to a year. If a state finds someone not eligible for Medicaid, they won’t be cut immediately, said Jennifer Tolbert, associate director for programs on Medicaid and the uninsured at the Kaiser Family Foundation. The Pennsylvania Department of Human Services said it will take a full year to do so and is working to ensure that no one experiences a lapse in health coverage.

The federal government also increased Medicaid funding to states in 2020, and this increased funding will not expire until the end of 2023. Tolbert said the move to keep people continuously enrolled on Medicaid is truly unprecedented, but will be one of the few permanent changes from the pandemic.

For example, Oregon will allow children who qualify for Medicaid to enroll at birth, and remain enrolled until age 6 without reapplying. Washington, California and New Mexico are also considering similar policies.

Another concern is what happens when the federally-funded supply of COVID-19 vaccines and tests runs out. Last August, the federal government announced that they had no more money from Congress to pay for COVID-19 vaccines. In March 2022, the federal government stopped paying for testing for uninsured patients.

George Mink Jr. is a community activist for Health Educated, a nonprofit in Delaware County that has hosted vaccine clinics, health fairs and webinars. They took advantage of free Covid testing and vaccines in the early stages of the pandemic. Mink said that if he had to have health insurance or pay for it himself, he might not have gotten tested. He had no serious health issues, but in 2020, a close family friend died of COVID-19. Mink and his family got tested and found out they were positive.

“Who knows what could have happened?” He says “We would still have been… infecting other people. It made a difference.”

Mink is also up to date with her COVID-19 vaccinations, but worries about what will happen when the vaccines are no longer free: “What if in two months, we have a new variant coming out and now I have a Need a new booster, and I can’t afford it now?”


Dr. Kristin Motley, a pharmacist, founded Health Educated, an outreach organization in Delaware County, Pa. For Flyers podcast she hosts with George Mink Jr. (Kimberly Poynter / WHYY).

Kimberly Poynter / Why


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Dr. Kristin Motley, a pharmacist, founded Health Educated, an outreach organization in Delaware County, Pa. For Flyers podcast she hosts with George Mink Jr. (Kimberly Poynter / WHYY).

Kimberly Poynter / Why

Health departments in Pennsylvania and Delaware say they plan to provide free testing and vaccines for the foreseeable future, and that the federal government has not yet said when the free vaccine supply will end. .

Pharmacist Kristin Motley, founder of the health education nonprofit where Mink works, would be sorry to see free vaccines.

“It allowed us to go into the community, wherever people were and to say, You don’t have to register, you don’t have to bring ID, you don’t have to bring insurance. You just come,” she says. “It was really nice to be able to help people without any red tape, without bureaucracy. It was very seamless.”

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