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As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage



By Hannah Recht

More than 600,000 Americans have lost Medicaid coverage since pandemic protections ended on April 1. And a KFF Health News analysis of state data shows the vast majority were removed from state rolls for not completing paperwork.

Under normal circumstances, states review their Medicaid enrollment lists regularly to ensure every recipient qualifies for coverage. But because of a nationwide pause in those reviews during the pandemic, the health insurance program for low-income and disabled Americans kept people covered even if they no longer qualified.

Now, in what’s known as the Medicaid unwinding, states are combing through rolls and deciding who stays and who goes. People who are no longer eligible or don’t complete paperwork in time will be dropped.

The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.


KFF Health News sought data from the 19 states that started cancellations by May 1. Based on records from 14 states that provided detailed numbers, either in response to a public records request or by posting online, 36% of people whose eligibility was reviewed have been disenrolled.

In Indiana, 53,000 residents lost coverage in the first month of the unwinding, 89% for procedural reasons like not returning renewal forms. State Rep. Ed Clere, a Republican, expressed dismay at those “staggering numbers” in a May 24 Medicaid advisory group meeting, repeatedly questioning state officials about forms mailed to out-of-date addresses and urging them to give people more than two weeks’ notice before canceling their coverage.

Clere warned that the cancellations set in motion an avoidable revolving door. Some people dropped from Medicaid will have to forgo filling prescriptions and cancel doctor visits because they can’t afford care. Months down the line, after untreated chronic illnesses spiral out of control, they’ll end up in the emergency room where social workers will need to again help them join the program, he said.

Before the unwinding, more than 1 in 4 Americans — 93 million — were covered by Medicaid or CHIP, the Children’s Health Insurance Program, according to KFF Health News’ analysis of the latest enrollment data. Half of all kids are covered by the programs.

About 15 million people will be dropped over the next year as states review participants’ eligibility in monthly tranches.


Most people will find health coverage through new jobs or qualify for subsidized plans through the Affordable Care Act. But millions of others, including many children, will become uninsured and unable to afford basic prescriptions or preventive care. The uninsured rate among those under 65 is projected to rise from a historical low of 8.3% today to 9.3% next year, according to the Congressional Budget Office.

Because each state is handling the unwinding differently, the share of enrollees dropped in the first weeks varies widely.

Several states are first reviewing people officials believe are no longer eligible or who haven’t recently used their insurance. High cancellation rates in those states should level out as the agencies move on to people who likely still qualify.

In Utah, nearly 56% of people included in early reviews were dropped. In New Hampshire, 44% received cancellation letters within the first two months — almost all for procedural reasons, like not returning paperwork.

But New Hampshire officials found that thousands of people who didn’t fill out the forms indeed earn too much to qualify, according to Henry Lipman, the state’s Medicaid director. They would have been denied anyway. Even so, more people than he expected are not returning renewal forms. “That tells us that we need to change up our strategy,” said Lipman.


In other states, like Virginia and Nebraska, which aren’t prioritizing renewals by likely eligibility, about 90% have been renewed.

Because of the three-year pause in renewals, many people on Medicaid have never been through the process or aren’t aware they may need to fill out long verification forms, as a recent KFF poll found. Some people moved and didn’t update their contact information.

And while agencies are required to assist enrollees who don’t speak English well, many are sending the forms in only a few common languages.

Tens of thousands of children are losing coverage, as researchers have warned, even though some may still qualify for Medicaid or CHIP. In its first month of reviews, South Dakota ended coverage for 10% of all Medicaid and CHIP enrollees in the state. More than half of them were children. In Arkansas, about 40% were kids.

Many parents don’t know that limits on household income are significantly higher for children than adults. Parents should fill out renewal forms even if they don’t qualify themselves, said Joan Alker, executive director of the Georgetown University Center for Children and Families.


New Hampshire has moved most families with children to the end of the review process. Lipman, the state’s Medicaid director, said his biggest worry is that a child will end up uninsured. Florida also planned to push kids with serious health conditions and other vulnerable groups to the end of the review line.

But according to Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project, state officials sent cancellation letters to several clients with disabled children who probably still qualify. She’s helping those families appeal.

Nearly 250,000 Floridians reviewed in the first month of the unwinding lost coverage, 82% of them for reasons like incomplete paperwork, the state reported to federal authorities. House Democrats from the state petitioned Republican Gov. Ron DeSantis to pause the unwinding.

Advocacy coalitions in both Florida and Arkansas also have called for investigations into the review process and a pause on cancellations.

The state is contacting enrollees by phone, email, and text, and continues to process late applications, said Tori Cuddy, a spokesperson for the Florida Department of Children and Families. Cuddy did not respond to questions about issues raised in the petitions.


Federal officials are investigating those complaints and any other problems that emerge, said Dan Tsai, director of the Center for Medicaid & CHIP Services. “If we find that the rules are not being followed, we will take action.”

His agency has directed states to automatically reenroll residents using data from other government programs like unemployment and food assistance when possible. Anyone who can’t be approved through that process must act quickly.

“For the past three years, people have been told to ignore the mail around this, that the renewal was not going to lead to a termination.” Suddenly that mail matters, he said.

Federal law requires states to tell people why they’re losing Medicaid coverage and how to appeal the decision.

Harmatz said some cancellation notices in Florida are vague and could violate due process rules. Letters that she’s seen say “your Medicaid for this period is ending” rather than providing a specific reason for disenrollment, like having too high an income or incomplete paperwork.


If a person requests a hearing before their cancellation takes effect, they can stay covered during the appeals process. Even after being disenrolled, many still have a 90-day window to restore coverage.

In New Hampshire, 13% of people deemed ineligible in the first month have asked for extra time to provide the necessary records. “If you’re eligible for Medicaid, we don’t want you to lose it,” said Lipman.

Clere, the Indiana state representative, pushed his state’s Medicaid officials during the May meeting to immediately make changes to avoid people unnecessarily becoming uninsured. One official responded that they’ll learn and improve over time.

“I’m just concerned that we’re going to be ‘learning’ as a result of people losing coverage,” Clere replied. “So I don’t want to learn at their expense.”KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.



Leadership WV takes a closer look at state’s health care system



Lewisburg, – With a goal of increasing awareness and understanding of the facilities, opportunities and medical philosophy at the West Virginia School of Osteopathic Medicine (WVSOM), Leadership West Virginia brought its 2023 class to the school’s campus Oct. 26 for tours and presentations.

WVSOM President James W. Nemitz, Ph.D., spoke to the Leadership class prior to members touring the teaching facilities.

“We are a leader in educating physicians for primary care medicine, especially in rural areas,” Nemitz said, noting that WVSOM is the state’s largest medical school, with an annual enrollment of more than 800 students.

Attracting West Virginia’s best pre-med students is a goal for WVSOM, Nemitz said, encouraging the Leadership West Virginia class members to recommend students to the school. The presentation included two videos: one on the values of osteopathic medicine and the other on why and how students should apply to WVSOM.

To a 2023 class that comprised 58 leaders from across the state, Nemitz spoke about WVSOM’s impact on West Virginia.


According to the school’s 2023 annual report, 850 WVSOM graduates were practicing in the state in 2022.

While noted for producing primary care physicians, the school also has graduates practicing in many specialties, Nemitz said.

He said that in addition to the school’s medical value, WVSOM represents a significant economic impact on the state and nation.

“We’re delivering more than $133 million to the state in direct contributions. When you add the contributions of our alumni who practice in the state, the health care delivery hours they’re generating and our students are generating, we hit more than $1.5 billion in West Virginia. And nationwide, it’s $9 billion,” he said.

The campus tour started with HealthNet Aeromedical Services landing a helicopter on the campus parade field for a presentation on HealthNet’s services and operation.


Earlier in the day, Nemitz joined Sherri Ferrell of the West Virginia Primary Care Association; Steve Seftchick of Highmark Blue Cross Blue Shield WV and Melanie Dempsey of the West Virginia Hospital Association for a panel discussion on the challenges of health care. Tony Gregory of the West Virginia Hospital Association moderated the question-and-answer session.

Health care is one of the areas of focus for Leadership West Virginia. Others include education, tourism, energy, the judicial system and the overall economy.

Full story here from The Register Herald


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Gov. Justice breaks ground, announces new Charles Calvin Rogers Veterans Nursing Facility in Beckley



Governor's Office

Governor’s Press Office

BECKLEY, WV — Last week, Gov. Jim Justice led a groundbreaking event for a much-anticipated new veterans nursing facility in Beckley. Gov. Justice joined veterans, state and elected officials, project managers, and directors from the West Virginia Department of Veterans Assistance for the ceremony.

Gov. Justice also announced that the facility will be named in honor of a Southern West Virginia Vietnam Veteran and Congressional Medal of Honor recipient: Fayette County native Charles Calvin Rogers. U.S Army Major General Rogers, a native of Claremont who died in 1990, earned the Medal of Honor following acts of heroism that took place near the Cambodian border on November 1, 1968.

“This is a truly special day for West Virginia and for our veterans, especially our veterans in Southern West Virginia,” Gov. Justice said. “This facility is going to be one of the best in the country, and it should be, because that’s what our veterans deserve. It’s especially meaningful because we get to honor General Charles Calvin Rogers, who is a true American military hero and one of our own.”

Read the entire story here: Gov. Justice breaks ground, announces naming of Charles Calvin Rogers Veterans Nursing Facility (



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Dr. PS Martin Named Director of WV Office of Emergency Medical Services



Dr. Matt Christiansen, State Health Officer and Commissioner of the West Virginia Department of Health and Human Resources’ (DHHR) Bureau for Public Health, today announces Dr. PS Martin as medical director for DHHR’s Office of Emergency Medical Services (OEMS), effective June 23, 2023. He replaces Dr. Beth Toppins, who served as interim OEMS medical director since April 2023.

“Dr. Martin brings a wealth of knowledge to this critical position with hands-on experience as a physician in emergency departments and as the medical director for multiple EMS agencies,” said Dr. Matthew Christiansen. “His unique and specialized background in the field of emergency medical services will be an asset to West Virginia, and will continue the work of Dr. Toppins. We are grateful for her service during a period of transition.”

Dr. Martin is an associate professor of emergency medicine at WVU’s School of Medicine and an emergency room physician at WVU Ruby Memorial Hospital, and is certified by both the American Board of Emergency Medicine and the American Board of Emergency Medicine Specializing in Emergency Medical Services. Dr. Martin earned his doctor of medicine degree and bachelor’s degree from West Virginia University. 

“I am honored to lead this office, which does incredible work to support West Virginia’s EMS systems and residents,” said Dr. Martin. “I look forward to working with OEMS staff and partners to  optimize the quality of emergency care across the state and improve the job satisfaction of our dedicated EMS providers.”


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