ICYMI: Medicaid Redeterminations Protect the Most Vulnerable
This week, Sally Pipes, President of the Pacific Research Institute, wrote a column sounding the alarm on the importance of protecting the most vulnerable in the Medicaid program through the redetermination process.
What is Redetermination? Redetermination is when a state conducts eligibility reviews for Medicaid recipients. That routine practice was put on pause during the COVID-19 pandemic. As a result, there are now over 18 million ineligible enrollees in the Medicaid program as of April 2023, according to the Paragon Health Institute.
Why is This a Problem? This pause jeopardizes services for vulnerable patients who rely on Medicaid—including children and people with disabilities.
It has also added to the $80 billion in improper Medicaid payments made in Fiscal Year 2022, worsening our national debt.
Despite this, Democrats are insistent that we should not reinstitute Medicaid redeterminations. They are opposing commonsense policies to protect Medicaid and those who rely on it.
- Secretary of Health and Human Services Xavier Becerra and Administrator for Centers for Medicare and Medicaid Services Chiquita Brooks-LaSure have publicly spoke out against Medicaid redeterminations, with Pipes noting that “the Biden administration has paused the process in 12 states since April.”
Here’s how Medicaid Redeterminations protect our nation’s most vulnerable patients.
Waste, Fraud, and Abuse Threatens Medicaid for the Most Vulnerable. Medicaid is a critical lifeline for the most vulnerable populations in the U.S. We must protect the integrity of the program for those who need it most.
- As Pipes wrote: “Each ineligible enrollee who remains in Medicaid strains the cash-strapped program…Medicaid needs every dollar it can get. As it is, too many Medicaid enrollees struggle to secure appointments with physicians and often receive subpar care.”
Redeterminations are Necessary to Protect Medicaid. Contrary to Democrats’ claims, the redetermination process ensures Medicaid is protected for the most vulnerable populations.
- While Democrats have claimed redeterminations will reduce Medicaid coverage among eligible groups, Pipes finds that “this concern is misplaced. Most of those who will lose Medicaid are not actually eligible for the program. The longer they stay enrolled, the more stress there is on the program — and the more enrollees who are actually entitled to coverage suffer.”
Many Impacted Medicaid Beneficiaries Already Have Private Insurance Coverage. Studies show that the federal government has been sending money to states to cover Medicaid beneficiaries who have already moved onto private insurance plans.
- “As research from the Paragon Institute points out, nearly half of [the group impacted by redeterminations] already had employer-sponsored coverage while enrolled in Medicaid. Private insurers contract to manage health plans for many Medicaid beneficiaries. So taxpayers have been sending significant sums to private insurers to cover Medicaid beneficiaries who had no intent of using that coverage,” Pipes said.
Redeterminations Will Not Significantly Reduce Coverage. Studies from even left-leaning think tanks project the vast majority of those disenrolled from Medicaid through redeterminations will have access to other forms of health coverage.
- “The Urban Institute estimates that just 1% of those who are disenrolled will not have access to other sources of coverage,” Pipes said, “whether the Children's Health Insurance Program, subsidized plans through Obamacare's exchanges, or other non-group coverage."
The Bottom Line: As Pipes said, “by thwarting state efforts to remove ineligible people from their Medicaid rolls, Democrats are making things more difficult for the program's intended beneficiaries—and exacerbating its long-term fiscal problems.”
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