It’s one of the biggest mysteries in health policy: What happened to millions of Americans kicked out of Medicaid last year?
A survey conducted for state officials in Utah, obtained by KFF Health News, holds some clues.
Like many states, Utah terminated Medicaid coverage for a large share of enrollees whose eligibility was reevaluated in 2023, following a three-year pause during the coronavirus pandemic. And like most states, an overwhelming share of those disenrollments were made for procedural reasons, such as missing paperwork.
More than 13.3 million people were disenrolled from Medicaid in 2023, according to KFF, and just over 70 percent of disenrollments were for procedural reasons.
It’s been unclear what led to those procedural terminations in Utah and other states. But the Utah survey of more than 1,000 disenrolled Medicaid beneficiaries, conducted in October, found that 57 percent of people who left the program in 2023 never tried to renew their coverage.
The good news is that many of them found insurance elsewhere — 39 percent through an employer, and 15 percent through the Affordable Care Act marketplaces, according to the survey.
The bad news is that 30 percent became uninsured, and many people reported obstacles in reapplying for Medicaid, which covers low-income and disabled people.
Nineteen percent said they never received renewal documents from the Utah Medicaid enrollment agency, the Department of Workforce Services. Fourteen percent said they didn’t get around to the paperwork, 13 percent said it was too difficult, and 7 percent said they didn’t have the necessary documents to prove their eligibility.
The survey found that many disenrolled people who asked why had trouble getting questions answered by the state Medicaid agency. While 39 percent polled said they were able to resolve their issue the same day or the next day, 12 percent waited over two weeks and 21 percent said their question or complaint was never resolved.
Half of those disenrolled described the renewal process as difficult. Just a quarter found it to be easy.
The online survey had a margin of error of plus-or-minus 3 percent.
Medicaid beneficiaries typically must have their eligibility reviewed every year to renew their coverage. But in March 2020, after the pandemic hit, the federal government froze eligibility checks as part of the public health emergency. That kept anyone from being dropped.
Since the spring, when Congress ended the emergency, states have begun once again reviewing eligibility for Medicaid beneficiaries — and terminating coverage for millions. The “unwinding” is scheduled to continue through May of this year, though some states have already completed it.
Utah has dropped about 150,000 of about 500,000 Medicaid beneficiaries since April.
Stephanie Burdick, a Medicaid enrollee and consumer advocate on Utah’s Medicaid advisory board, said the state’s survey results point to serious shortcomings in Utah’s unwinding.
“It’s a huge communication failure,” she said when asked why more than half of those dropped made no effort to renew their coverage. Many Medicaid enrollees, she said, didn’t know they had to reapply.
“A lot of people thought it was like the federal stimulus checks and was just a one-time benefit,” she said.
Jennifer Strohecker, Utah’s Medicaid director, said the state is using feedback from the survey to improve its consumer engagement. It’s renewing more beneficiaries using databases to verify their income and residency, she said, and is assisting with enrollment at laundromats and Department of Motor Vehicles offices.
The state’s strong economy and low unemployment rate may help explain the high percentage of people terminated from Medicaid, she said. And about 35 percent who were disenrolled are returning to the program, said Kevin Burt, deputy director of the Utah Department of Workforce Services.
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