When the COVID-19-era policy of continuous Medicaid eligibility came to an end and the process known as Medicaid unwinding began, policymakers expected significant numbers of people who lost their Medicaid eligibility to find new, affordable coverage in Affordable Care Act health insurance exchange plans.

But while bureaucratic snafus that have resulted in millions of people losing their Medicaid eligibility because of paperwork problems rather than income that exceeded Medicaid eligibility criteria have received the most post-pandemic attention, other challenges have arisen that are preventing people from finding new, affordable insurance to replace their Medicaid coverage.  Among them:

• ACA plans are processing applications too slowly.
• Notices to individuals losing their Medicaid eligibility fail to explain the situation clearly.
• State Medicaid offices are inadequately staffed to respond to questions.
• Notices to people losing their Medicaid coverage do not even mention the option of pursuing low-cost insurance on an ACA exchange.
• Staff hired to help people through their transition from Medicaid to commercial insurance is overwhelmed with work.

Some states appear to be trying harder than others to fix these problems.  Rhode Island, for example, is helping to pay some former Medicaid recipients’ insurance premiums while they navigate the process of applying for new health insurance.  Virginia, on the other hand, does not even explain to people why they lost their Medicaid coverage.

People losing Medicaid coverage poses an especially serious challenge for community safety-net hospitals because they care for such higher proportions and numbers of low-income patients than the typical American hospital.  As a result, they are more likely than others to find that some of their patients, including many in the middle of a course of treatment or care, no longer have the means to pay for that care, resulting in unexpected and troubling uncompensated care for the hospital and medical debt for their patients.

For a look at some of the challenges Medicaid beneficiaries and state governments are encountering during the Medicaid unwinding process, see the Washington Post article “Medicaid rolls are being cut. Few are finding refuge in ACA plans.”