As Medicaid downsizes in the aftermath of the coronavirus pandemic, reporting by New York and other states is missing data on an important group – outgoing enrollees who successfully made the switch to job-based insurance.

In New York, there’s reason to believe that many if not most of the million-plus people due to leave the Medicaid rolls over the next year will end up with employer-provided health benefits.

That shift should be welcomed – because greater use of commercial insurance means lower costs for taxpayers, more choice for consumers and better reimbursement for caregivers.

Yet the state’s first monthly report on the Medicaid “unwinding” process, issued last week, did not track the flow to employer-sponsored insurance.

The report said that about 159,000 enrollees had lost their coverage in June, either because they were no longer eligible or failed to complete the paperwork for reapplying. That number included both people who are well-insured through jobs and others who fell through the cracks – confusingly lumping together positive outcomes with negative ones.

The report, issued by New York State of Health insurance exchange, acknowledged that “a significant number of individuals are estimated to have gained health coverage through an employer, meaning that individuals who do not come back to renew should not be assumed to be uninsured.”

The report said the Health Department is “unable to track coverage” for people who have left state-funded or state-managed health plans. Indeed, former enrollees are not obliged to give that information to the state – and the state is not specifically obliged to tabulate it.

Still, the state is not completely in the dark. At a United Hospital Fund forum in February, a Health Department official said the state was aware of “many hundred thousand” Medicaid recipients who were simultaneously enrolled in employer-sponsored insurance.

This was a byproduct of a special federal rule put in place at the start of the pandemic which barred states from enforcing normal enrollment rules during the public health emergency. As the economy recovered and people rejoined the workforce, this “continuous coverage” requirement caused nationwide Medicaid rolls to temporarily swell with people who would normally be ineligible.

At the February forum, officials projected that 1.2 million New Yorkers currently enrolled in Medicaid or other state-sponsored plans would switch to employer coverage during the unwinding process, while about 100,000 would become uninsured.

At the same event, the deputy director of state exchange, Sonia Sekhar, said the state had a policy of switching enrollees with job-based coverage into fee-for-service Medicaid, in which the state directly pays providers an on as-needed basis, as opposed to Medicaid managed care, in which the state pays a monthly premium to a private health plan. This avoided spending money on premiums for people with alternate coverage – and effectively gave the state a head-start on its goal of moving 1 million enrollees out of the program completely. 

As Sekhar explained:

We never turned off moving people from Medicaid managed care to fee for service when either the member reported that they have [employer-sponsored insurance] or whether one of our data sources indicated they have ESI. … I would say many hundred thousand people have already transitioned based on those hits to the data sources or self-reporting that they have ESI. So I know that 1 million number is kind of daunting. Some of that transition has already happened. 

This indicates that the state has at least a partial count of how many enrollees have jobs with health benefits – and are at low risk of becoming uninsured as the unwinding process continues.

Including this cohort in a lump-sum tally of people losing Medicaid coverage gives the public an exaggerated idea of how many are actually at risk of falling through the cracks – and unnecessarily heightens concern about the unwinding process.

The state has the ability to clarify the situation by disclosing how many enrollees it believes to have job-based insurance, as well as how many of that group are leaving the rolls on a monthly. It should share that information as soon as it can – and include it in future progress reports.


About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

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