The Return of Churn: State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018

In 2018, enrollment in Medicaid and the Children’s Health Insurance Program decreased by about 1.6 million enrollees, 744,000 of which were children. The three states with the largest percentage drops in enrollment were Tennessee, Arkansas, and Missouri. Texas also saw a large nominal drops in Medicaid and CHIP enrollment. There is strong evidence that a driving factor of the decline in enrollment is state policy decisions to engage in punitive annual (or even monthly) eligibility redetermination processes in which large percentages of Medicaid enrollees lose coverage.

Eligibility redetermination enrollment losses—often called enrollment “churn” in health policy and politics—are an old problem in Medicaid, but a problem that should have been greatly reduced by the Affordable Care Act (ACA). Federal law and regulations put in place by the ACA likely prohibit many of the processes described in this report. More than five years after these requirements came into force, some states do not comply with all federal regulations for redetermining eligibility and use outdated processes for verifying income and state residence that put an unnecessary burden on beneficiaries and create additional barriers to health insurance coverage. As a result, beneficiaries struggle to navigate their renewal processes and lose their Medicaid eligibility even though they may qualify. To read the full analysis download the PDF here.