Medicaid’s Great Unwinding Will Leave Up to 200,000 New Yorkers Fully Uninsured

Issue 280

Means-testing health care for the poor is making a comeback. Don't let new paperwork hurdles trip you up.

Amba Guerguerian Jun 15, 2023

During the pandemic, the number of New York State residents enrolled in Medicaid rose from 6.1 million to 7.8 million. This was due to a 2020 federal law that suspended annual paperwork requirements that often discourage low-income Americans from applying for the federally-funded program. 

The belief that someone somewhere is receiving a ­government benefit they are not entitled to is a hallmark of America’s stingy social safety net. Means testing is the instrument for enforcing this ideology of scarcity. And it is returning with a vengeance for the vast majority of the 92.3 million Medicaid users in the United States who will have to “recertify” for public health care in order to avoid losing their coverage. 

This “unwinding,” as it is called, began on April 1. In Republican-led states such as Florida and South Dakota, hundreds of thousands of residents were swiftly removed from their Medicaid rolls. New York is taking a more gradual approach, but State health officials say the number of Medicaid recipients could drop by 1.3 million over the next year. Many of those New Yorkers are expected to find other kinds of coverage, though they could face higher costs at a time when inflation is already running high. Meanwhile, 100,000–200,000 people in the state could become fully uninsured, including some who would qualify for Medicaid coverage but will fail to submit the proper paperwork. 

How it went down

As a part of the expanded social-safety net spurred by the onset of COVID-19, Congress required state Medicaid and Children Health Insurance (CHIP) programs to keep people continuously enrolled throughout the pandemic in exchange for federal funding. In December 2022, Congress passed a law ending continuous enrollment on March 31 of this year. The bipartisan deal gives states 12 months to initiate renewals for government-subsidized health care and 14 months total to complete them. 

More than 9 million New Yorkers will need to recertify to see whether they still qualify for government-sponsored insurance.

Who receives Medicaid? Children, pregnant people, low-income adults, elders and people with disabilities. 

The uninsured rate nationwide has dropped by 18% since 2019, according to the CDC. But, as the recertification process begins, millions are at risk of losing coverage, reducing recent gains. 

The Congressional Budget Office estimates that 6.2 million people will likely be left without any insurance after unwinding. The Department of Health and Human Services estimates that upwards of 15 million people nationwide could lose Medicaid coverage specifically, “including 7 million who actually remain eligible for the program but fail to jump through the bureaucratic hoops!” Adam Gaffney, an ICU doctor at the Cambridge Health Alliance, told Common Dreams

Some states, like New York, have launched public outreach campaigns to ensure Medicaid recipients understand how to recertify. California and Rhode Island are even planning to auto-enroll Medicaid recipients into state-based marketplaces. 

Health care isn’t the only part of the social-safety net shrinking. Since March 1, certain SNAP benefits were cut in over 30 states, including New York. The end of pandemic emergency allotments is leading to a reduction of at least $95 per month in SNAP. Some U.S. households are experiencing cuts from $250 to $30 per month. Additionally, the boosted Child Tax Credit (CTC) expired after one year in late 2021, resulting in a 41% surge in child poverty. 

In New York

More than 9 million New Yorkers — the nearly 8 million covered by Medicaid/CHIP and an additional million on the Essential Plan — will need to recertify to see whether they still qualify for government-sponsored insurance. New York City will be disproportionately affected, with 56% of the state’s Medicaid/CHIP users residing here. 

The State has taken some steps to protect the most vulnerable Medicaid users from losing coverage, such as automatically renewing coverage for people over 65 and those with disabilities. 

Recertifications will be sent in batches over the course of 12 months. Automatic renewal will continue for New Yorkers until July 1, but if your health insurance expires any time after that, you will need to recertify for this year before then in ­order to avoid any gaps in coverage. 

The State will contact you via the communication method you’ve indicated on your State of Health account — electronically or by mail. You should call the New York State of Health (NYSOH) at (855) 355-5777 or go into your account to ensure that your contact information and communication method are updated and to check when you need to recertify. 

And, some New Yorkers were already sent recertification notices, so you should call the NYSOH if you think you may not have been receiving mail, texts or emails from the State due to negligence or incorrect contact information. You can also sign up for text messaging with NYSOH to get reminders of important deadlines and updates regarding your health plan by texting “START” to (866) 988-0327. 

Many people don’t realize they are at risk of losing their Medicaid coverage.

The recertification requirement applies to those covered by Medicaid through New York City’s Human Resources ­Administration (HRA), which sent out letters to its clients at the onset of Medicaid unwinding. People enrolled in the State’s emergency Medicaid program for undocumented people will also have to recertify. 

The State has increased Medicaid income-eligibility levels. The maximum income for a single person is now $1,677 per month. 

If you no longer qualify for Medicaid but aren’t insured through your job and haven’t received a large increase in income, you likely will still qualify for government-subsidized health insurance. New York’s Essential Plan for low-income individuals will be available to some, and new federal tax-credit guidelines will make coverage more affordable for individuals transitioning to commercial plans available through the NYSOH marketplace. 

The State says it will increase its customer-service-center staffing to above pre-pandemic levels to handle the anticipated call volume. Despite these efforts, more than one  million New Yorkers could be dropped from public insurance due to unwinding, according to the Robert Wood Johnson ­Foundation. While the majority of New Yorkers will likely be assigned to other plans, the organization projects that the state’s uninsured numbers could rise 20%.

More than half of 415 New York respondents to a poll ­conducted by Make the Road said they were unaware they would have to get their coverage renewed once the federal public-health emergency around COVID-19 was over. 

Grassroots outreach

While being on the lookout for communication from the State of Health doesn’t sound too difficult, the reality is that mail gets lost or forgotten, mass texts are often ignored and we’re more hesitant than ever to give our private information over the phone. It’s necessary to meet people where they’re at.

There would be no “unwinding” if we had a universal system of free or low-cost public health care

When the news broke late last year that Medicaid unwinding would begin April 1, the state encouraged the Community Service Society (CSS) of New York to start working on a campaign called Keep New York Covered. CSS secured program funding from eight foundations and has partnered with 36 smaller organizations around the state. 

“We have awarded over $1.3 million to these small, grassroots, community-based groups that are all certified by the State to provide enrollment services so that they can get the word out to their clients and beyond,” Elisabeth Benjamin, VP of Health Initiatives at CSS, told The Indypendent.

“You need boots on the ground, people that [enrollees] can trust to come to if they get a notice in the mail. It’s not gonna get done by a state agency calling someone, especially with so much distrust between communities and government,” says Maria Lizardo, executive director of Northern Manhattan Improvement Corporation, a community organization that has received grant money for unwinding outreach and to assist people with the recertification process. 

“Anywhere we can be at where we can meet community members, that’s where we’re at,” Lizardo told The Indy in early June at a neighborhood carnival on St. Nicholas Ave. in Washington Heights. A variety of health and public-services tables were located next to the event’s bandstand, urging people to interact with them. All of NMIC’s handouts were gone hours before the event ended.

Most of NMIC’s clients speak Spanish and prefer to communicate face-to-face. “Univision and Telemundo — along with word of mouth — are some of the most common ways of communicating this; I’ve seen a lot of clients come in because of they watch those channels all the time,” says Alba Fresco, Coordinating Health Care Navigator at NMIC, about people who come to the organization for assistance with Medicaid recertifications. 

If you don’t want to have to deal with recertifying alone, reach out to an organization in your neighborhood that is equipped to help people with government-sponsored health insurance, or call CSS at (888) 614-5400 for help finding one. 

An easier way

While the effort that the State and its partners are undertaking is a mighty one, there would be no “unwinding” if we had a universal system of free or low-cost public health care in which we wouldn’t be price gouged for essential medications or hunted down by collection agencies for medical bills.

“If we took all the resources we spent on health-care coverage through our patchwork system and just had, for example, Medicare for all,” Elisabeth Benjamin told The Indy, “then people would be enrolled in coverage as a resident of the United States and providers would get paid, and the whole system would be probably be a lot more user-friendly for patients. For patients, our system does not work very well.”

Correction: An earlier version of this article stated that NMIC received grant money from CSS New York.

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