States comb through Medicaid rolls to see who can stay and who should go

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Nearly 4 million people across the country have recently lost their Medicaid coverage. The reason? Pandemic protections expired in April. Now every state is going through their rolls, confirming some people can stay, and others are getting cut off. NPR's Selena Simmons-Duffin has the latest on how this process is going.

SELENA SIMMONS-DUFFIN, BYLINE: Just a few months ago, in March, the number of people with Medicaid was an astonishing 93 million. That's about 1 in 4 people in the country on Medicaid, the public health insurance program for people with low incomes. That's more than ever before. It's not surprising when you think about it. For three years, states let new people enroll without kicking anyone off. So the rolls grew and grew. Now it's time for what's been called the great unwinding, a return to the usual process of checking everyone's eligibility every year. Some people are losing coverage because they don't qualify anymore. Maybe they make too much money now. But 74% of people on average are losing coverage for paperwork reasons, says Jennifer Tolbert, director of state health reform at KFF. That means...

JENNIFER TOLBERT: They didn't get the renewal notice in time. They didn't understand what they needed to do. Or they submitted the documents, but the state was unable to process those documents before their coverage was ended.

SIMMONS-DUFFIN: She does say some people who were wrongly cut off will quickly reenroll, although even losing coverage briefly can be really disruptive and stressful if you're sick or can't get your medicine. Medicaid is managed by each state, so there is a lot of variation in how states are doing this.

TOLBERT: In Texas, in this first month of unwinding data that they reported, they actually reported disenrolling 82%.

SIMMONS-DUFFIN: That's compared to 8% in Wyoming. Tolbert says they don't have all the information to understand exactly what's behind this variation state to state. In Arkansas, documents weren't getting returned from the Marshallese community in the state, says Keesa Smith. She used to work for the state's Department of Human Services. Now she's an advocate at a nonprofit. And she spoke last week with the Center for Health Journalism at USC.

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KEESA SMITH: The documents that DHS had had translated into Marshallese did not actually make sense. Like, the one thing that did translate was that these individuals had done something drastically wrong.

SIMMONS-DUFFIN: Experts and advocates say if you've lost Medicaid, you do have options. If it was a paperwork glitch, you can reenroll. If you're no longer eligible, you may qualify for a plan at healthcare.gov that's subsidized, so the monthly cost is low. Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.