About 149,000 Michiganders have lost Medicaid coverage in a 16-month period
\nNo one\u2019s sure why, but they have theories
\nIt\u2019s a particular concern now, as Michigan and other states prepare to enforce federal requirements that could squeeze more people from coverage<\/p>\n
As states prepare to tighten access around Medicaid benefits, Michigan is facing the possibility of a big rise in people without health insurance.\u00a0<\/p>\n
That includes more than 149,000 people who have already vanished from its Medicaid program in the last 16 months for reasons that elude many experts.<\/p>\n
They do not appear to have gained coverage through employers \u2014 at least not all of them, according to the Michigan Association of Health Plans, which tracks insurance enrollment data.<\/p>\n
Nor do those 149,000 \u2014 representing a drop of more than 5% in total enrollment \u2014 appear to have migrated en masse to the federal marketplace where consumers buy insurance directly.<\/p>\n
It\u2019s a particular concern now for advocates for Michigan\u2019s low-income and disabled residents, who worry that many of those 149,000 residents are now uninsured.<\/p>\n
Related: <\/p>\n
\u201cWe just don’t know what is driving that loss in enrollment,\u201d said Dominick Pallone, executive director of the insurance association.<\/p>\n
There are several theories for the decline \u2014 from confusion about ever-changing policies to the immigration crackdown to cuts in critical staff. Some even cite a better economy.\u00a0<\/p>\n
But it comes as even more Michiganders are likely to lose coverage through Medicaid starting next year.<\/p>\n
Michigan and other states are gearing up for new federal requirements<\/a> that will force beneficiaries next year to prove they are working, looking for work, engaged in the community, going to school or in a training program.<\/p>\n The Trump administration is still releasing guidance on those requirements \u2014 the latest arrived this week<\/a>. In Michigan, the Whitmer administration has estimated<\/a> that up to 200,000 residents will lose coverage under the new requirements, including some who are eligible, but fail to submit all their necessary documentation.<\/p>\n \u201cWe\u2019re looking down the end of the barrel here,\u201d said Jeremy Lapedis, executive director of the Washtenaw Health Project, an Ann Arbor-based nonprofit that works with the Washtenaw County health department to help residents find affordable coverage.<\/p>\n Left without coverage, those Michiganders will seek treatment only when it\u2019s most serious and most expensive, Lapedis said.<\/p>\n It\u2019s a problem that leads to medical debt<\/a> for the individual and drives up health care costs for everyone.<\/p>\n \u201cThose costs (for uninsured people) have to shift somewhere \u2014 whether it\u2019s on the hospitals or places like ours,\u201d said Jessica Kowalski, deputy director of clinical operations at the ACCESS Community Health and Research Center, a Dearborn-based community service organization that provides medical care.<\/p>\n The drop in Medicaid enrollment over the past year or so \u2014 even before new federal requirements, \u201cmay be a precursor to what we’re going to see in the future, which is just a huge stress to the entire health care system,\u201d said Jeremy Lapedis, executive director of the Washtenaw Health Project, an Ann Arbor-based nonprofit that works with the Washtenaw County health department to help residents find affordable coverage.<\/p>\n In fact, the numbers of Michiganders covered by Medicaid significantly dropped the latter half of last year \u2014 more so<\/a> than the US in general, according to KFF, a San Francisco-based nonprofit focused on health research.<\/p>\n At ACCESS, staff see the change firsthand, said Kowalski.<\/p>\n \u201cPeople are coming in and we check their insurance,\u201d Kowalski said, \u201cand we tell them, \u2018Your insurance is inactive.\u2019 They’re shocked. They’re like, \u2018What do you mean?\u2019\u201d<\/p>\n State officials appear baffled at the loss, too.<\/p>\n The Michigan Department of Health and Human Services is \u201cmonitoring this trend closely,\u201d department spokesperson Laina Stebbins said in an email to Bridge.<\/p>\n \u201cIdentifying and understanding the factors driving this decline is an important area of focus for the department,\u201d she wrote.<\/p>\n Post-COVID rightsizing or a concern?<\/p>\n There\u2019s an argument that Michigan\u2019s Medicaid program \u2014 one that cost $25 billion<\/a> in 2024, according to the most recent numbers \u2014 is simply being made more efficient and slicing out what critics, including President Trump, say is waste and abuse<\/a>.<\/p>\n Whatever the cause for the declining enrollment, it means less taxpayer money being spent on Medicaid in the short-term.<\/p>\n Cost savings weren’t immediately available on Wednesday but likely tally tens of millions of dollars a year.<\/p>\n By one 2022 estimate<\/a>, an additional 775,000 people getting Michigan Medicaid during the pandemic cost Michigan taxpayers $50 million a month.<\/p>\n \u201cIt’s always easy to take the negative side of this, but I think the good part is that we’ve been able to graduate some people off Medicaid,\u201d state Rep. Curt VanderWall, R-Ludington, said. \u201cThey’ve actually found full-time employment \u2026 and (become) independent.\u201d<\/p>\n State Rep. Phil Green, R-Watertown Township, agreed. He\u2019s vice chair on the House Appropriations Subcommittee on Medicaid and Behavioral Health.<\/p>\n There\u2019s a \u201cplethora of reasons\u201d \u2014 good and bad \u2014 behind the disenrollments, he said.<\/p>\n \u201cI think without doing \u2026 exit interviews, we’re just sort of surmising,\u201d the reasons behind the enrollment drop, he said.\u00a0<\/p>\n And long term, the shrinking enrollment is less stark: Enrollment last month remained slightly above enrollment just prior to the pandemic: There were about 46,000 more people in Medicaid in April then in March 2020, the month Michigan confirmed its first COVID case.<\/p>\n \u2018Churn\u2019<\/p>\n Certainly, monthly enrollment in Medicaid fluctuates. It exploded, in fact, during COVID.<\/p>\n As the pandemic gripped the US in 2020, Michigan and other states suspended annual eligibility reviews that caused a \u201cchurn\u201d of people in and out of Medicaid each month.\u00a0<\/p>\n With few exceptions, federal law prevented anyone from being disenrolled from Medicaid during the pandemic. The goal was to help people remain insured during the global health scare and economic upheaval.<\/p>\n By June 2023, that meant that nearly 3.3 million Michiganders \u2014 nearly\u00a0<\/p>\n 1 in 3 \u2014 was covered either by traditional Medicaid, which generally covers the lowest-income or disabled residents, and Healthy Michigan, which covers those whose family income is up to 138% of the federal poverty level and are relatively healthy.<\/p>\n In June that year, annual reviews restarted under the direction of the Biden administration. The year-long process, known as \u201cunwinding,\u201d whittled Michigan\u2019s Medicaid back to fewer than 2.7 million by the end of 2024, according to state data.<\/p>\n That\u2019s when experts expected enrollment to stabilize.<\/p>\n But since then, enrollment has continued to tumble \u2014 to just over 2.5 million by the end of April 2026, according to state data<\/a>.<\/p>\n \u201cYou would have expected (the decline) to level off at some point,\u201d said Lapedis at the Washtenaw Health Project<\/a>. \u201cIt hasn\u2019t, and we don’t know why.\u201d<\/p>\n Moreover, more than 175,000 Medicaid beneficiaries are now enrolled in Plan First, a Medicaid plan launched in 2023 that provides narrow coverage limited to sexual health only.<\/p>\n While Plan First beneficiaries would have no coverage at all otherwise<\/a>, their numbers further inflates the total size of Michigan\u2019s Medicaid enrollees, said Pallone at the insurance industry group.<\/p>\n Anxiety, aging and other theories<\/p>\n Advocates have offered several theories for the drop in Medicaid enrollment. Among them: anxiety.<\/p>\n The debate last year and ultimate passage<\/a> of the \u201cBig, Beautiful Bill,\u201d made it clear that big cuts and stricter rules in Medicaid are ahead<\/a>.\u00a0<\/p>\n Confused, some Michiganders \u201cmight just not be re-enrolling or applying to begin with,\u201d said Amber Bellazaire<\/a>, a senior policy analyst for the Michigan League for Public Policy<\/a>, a Lansing-based nonprofit organization that advocates for low-income Michiganders.<\/p>\n Additionally, a high-profile, nationwide crackdown<\/a> on immigration likely forced down enrollment, too, said Jennifer Tolbert<\/a>, deputy director of the Program on Medicaid and the Uninsured at KFF, a nonprofit health policy research, polling, and news organization.\u00a0<\/p>\n Undocumented immigrants do not have access to full Medicaid benefits in Michigan; however, they may get emergency care, according to state eligibility criteria<\/a>.<\/p>\n \u201cThat population is on edge right now for good reason,\u201d agreed Pallone, at the insurance group. \u201cThey could be a total lawful citizen, properly enrolled in Medicaid \u2026 and worry that they’re going to get swept up in some ICE raid at (a state government) office if they go and show up to reapply.\u201d<\/p>\n Another theory: Michigan is aging faster than other states<\/a>. About 380 Michiganders each day turn 65, the age at which they age into Medicare.<\/p>\n And it may be, as VanderWall suggested, that some Michiganders have taken higher-paying jobs after the pandemic, and they\u2019re accessing insurance now through their employers or the individual marketplace, www.healthcare.gov<\/a>, Pallone said.<\/p>\n Still, any growth in Medicare, employer-sponsored or marketplace plans falls far short of 149,000 people, he added.<\/p>\n \u2018Slashed\u2019<\/p>\n Pallone also believes short staffing at local state offices has disrupted coverage for some beneficiaries who need in-person help.<\/p>\n \u201cThat\u2019s a leading theory right now,\u201d he said.<\/p>\n