Many Americans are unclear about what Medicaid actually is. In brief: Medicaid provides health insurance coverage to low-income adults, pregnant people, and children. Roughly 60% of people on Medicaid and CHIP, a program that extends Medicaid coverage for low-income children, are 26 years old or under. Medicaid is also the largest payer of long-term services and supports, another reason it is critical to millions of people.
I’ve been on Medicaid since I turned 18. It has been a lifeline because it provides personal-care services that allow me to live in the larger community rather than in a private facility. For many Americans, though, Medicaid coverage is now at risk. Under the Consolidated Appropriations Act of 2023, states will resume redetermining eligibility for all Medicaid enrollees on April 1. That means an estimated 18 million people may lose their coverage in the next 14 months, including some people who enrolled during the pandemic, according to a report from the Urban Institute.
Like the White House’s plan to privatize COVID treatments and vaccines, Medicaid coverage is another public health emergency measure that’s been deemed no longer necessary. In early 2020, Congress enacted a rule that barred states from dropping people from Medicaid, thus ensuring access to health care during the pandemic. But now the government will allow the number of uninsured people to soar in an “unwinding” process that could have major consequences.
Every year, I have to go through a Medicaid redetermination process, which assesses my eligibility so that my coverage can be renewed. Even though I’ve been through this process seemingly countless times, when that thick packet from the county comes in the mail, it still creates a pit of dread in my stomach. One small error can be disastrous, resulting in what’s called “churn,” the gap in coverage that can lead to delays in care while people re-enroll — or people can fall through the cracks altogether. Administrative and procedural barriers can also lead to someone being dis-enrolled, with low-income people and people of color disproportionately at higher risk due to structural inequities.
The form I have to complete features the deadline and this sentence printed on the first page: “Your Medi-Cal [California’s Medicaid program] is still active for now. If you do not fill out and return your Annual Redetermination form, we will take steps to stop your Medi-Cal.” Nothing like the threat of losing essential care services to set you on edge.
I gather all of my information and carefully write my answers in pen as legibly as possible (that’s right, there isn’t an online option). I answer questions about my income, expenses and deductions, pregnancy and marital status, the amount of money I have in cash and in the bank, citizenship and disability status. I also have to complete a supplemental form listing any property I own, including retirement accounts, stocks, real estate, jewelry, vehicles, or other assets and resources valued at $500 or more. If I check “yes” to any of these things, I am required to provide documentation.
I triple check my answers and download documents such as my recent pay stubs and bank statements. The last thing I do is write a cover letter describing the attached documentation, with clarifications in case the social worker thinks I am violating income and asset limits that would make me ineligible. Each year I prepare and send my application well in advance of the deadline, grateful for the privilege of having a printer that can also scan and copy. I scan my completed form as a backup in case there is a dispute or claim that I did not send it in. After it’s finished, I put the application in the envelope provided, though it barely fits. I seal the bulging envelope with tape to secure it before my dad drops it off at the post office. (One year, my application was flagged and I had to fill out a longer form with more invasive personal questions, plus a warning that I may have to be evaluated by a doctor to “verify” that I am disabled.)
It is a lot of work to be poor and disabled. In a country where health care is not a right, the Medicaid redeterminations reinforce the precarious state of marginalized communities in relationship to the state. When I go through this process, I am angered as I think of all the people who need assistance trying to understand the form, collecting information, and physically completing it on time. The administrative burden, access barriers, and emotional toll it takes to jump through these hoops for survival is cruel and counterproductive.
In an extension of this cruelty, some Republicans are threatening to decimate Medicaid funding while protecting Medicare and Social Security in their upcoming budget proposals. The Washington Post reported that Donald Trump’s former budget director shared a 10-year proposal with Republicans that includes $2 trillion in cuts to Medicaid. Potential changes to the structure of Medicaid, such as instituting additional work and reporting requirements, will punish people for the mere fact they need health care.
For example, Arkansas was the first state to implement work and reporting requirements, which involved monthly reporting of work status through an online portal or phone. By the time a judge halted the work requirements program a year later, 18,000 Arkansans had lost coverage. Governor Sarah Huckabee announced in February that the state will submit a request to the federal government to resume work requirements for able-bodied adults who enroll in a program that would provide expanded Medicaid benefits. (She insists that the new proposal will comply with prior court rulings and won’t result in anyone losing Medicaid coverage.)
Medicaid expansion saves lives. But perhaps we should question whether we are considered human in the eyes of the GOP. If we don’t fight back, the “great unwinding” could become the great unraveling of the safety net as we know it.
I have faith, though, that people will save Medicaid once again, as they have with past efforts to repeal the Affordable Care Act. When the odds seem overwhelmingly stacked against us, I recall the phrase, “They tried to bury us, they didn’t know we were seeds.” We will rise again.
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