The Human Costs of Covid-Related Medicaid Expansion

A s SARS-CoV-2 spread through the U.S. in March 2020, congressional leaders passed several bills to provide relief to Americans experiencing financial hardship. The trillions of dollars in new spending included the Families First Coronavirus Response Act (FFCRA), a $192 billion package intended to strengthen social-safety-net programs during the pandemic. Under the FFCRA, the federal government increased its share of Medicaid spending, known as the Federal Medical Assistance Percentage (FMAP), by 6.2 percent. This grew Medicaid substantially, allowing greater numbers of Americans to receive government-sponsored health-care coverage under the program.

The FFCRA’s implementation has been predictably fraught with problems. Millions of newly enrolled Medicaid recipients are actually not eligible for the benefit or have not undergone scheduled reviews of their status, while others have been miscategorized altogether. As a result, Americans who would otherwise be unqualified for Medicaid have been added to the program’s rolls.

Ordinarily, the states are empowered to address such oversights, but under FFCRA, they’re forbidden from doing so; the only way ineligible enrollees may be removed from the program is to either voluntarily disenroll or to leave the state where they live. This means that states are in turn kept handcuffed to Medicaid and makes the program increasingly vulnerable to rampant fraud and abuse.

As our nation hits $30 trillion in debt, tens of billions of dollars in misdirected Medicaid spending may seem like a mere rounding error. But there are true human costs associated with these policies, and the Americans for whom programs such as Medicaid were created are the ones who pay them.

While millions of ineligible Americans occupy the Medicaid rolls, many with legitimate needs languish on waiting lists.

In Florida, 72,000 residents with chronic illness or severe disability await enrollment.

In Arkansas, Skylar Overman and other children with disabilities can wait more than a decade to receive the Medicaid coverage they need. Overman was born with a rare neurological condition, schizencephaly, that keeps her wheelchair-bound and requires round-the-clock care. Her parents worried that she would die before being granted access to Medicaid. They spent more than ten years fighting to make sure that didn’t happen, during which time Arkansas added more than 300,000 able-bodied adults to its Medicaid rolls.

In Missouri, Wynester Logan spent years advocating for her 22-year-old son, Marcus, to be awarded the Medicaid benefits to which he was entitled. Marcus has severe autism and epilepsy, and he is unable to speak or live independently. His extreme disability necessitates respite care, but without Medicaid coverage, his housing situation is insecure: He has to reside permanently in a short-term-care facility. As Wynester endured treatment for stage IV breast cancer, her mind was preoccupied not with her own health, but instead with how Marcus would survive.

Marcus Logan and Skylar Overman are not alone. A 2018 study by the Foundation for Government Accountability (FGA), where I serve as the communications director, found that there were nearly 250,000 truly needy individuals awaiting enrollment in the states that participated in Obamacare’s Medicaid expansion, and nearly 22,000 in those states had died while on a waitlist since Obamacare went into effect. With total enrollment hitting a record high of nearly 90 million as a result of the FFCRA, the number of Americans stuck on waiting lists has inevitably risen, too.

Americans believe in community; that’s why we designed social-safety-net programs to protect those among us who are in genuine need of our support. But the radical expansion of these programs to include an able-bodied, working-age population has left behind the very people they were originally intended to help.

Today, the Bureau of Labor Statistics (BLS) reports 10.9 million positions available to job seekers, as businesses offer record raises and big incentives to try to attract applicants. Yet, millions of qualified Americans remain trapped in a cycle of dependency, relying instead on the government to meet basic needs such as medical care.

In 2020 alone, Oregon saw a 12 percent increase in Medicaid enrollment, while Kentucky’s enrollment was up 13 percent and Indiana’s skyrocketed 15 percent. Across the country, the number of Medicaid beneficiaries grew by an average of 10 percent per state. Sixty-two percent of voters agree that states should not be required to keep ineligible individuals on their Medicaid rolls. But thanks to stipulations in the FFCRA, there is no end to enrollment growth in sight.

Lawmakers promised that the FFCRA would simply serve as a stopgap for Americans affected by compulsory closures of businesses due to the pandemic, stipulating that the benefits would end at the end of the designated “Public Health Emergency” (PHE) period. But this has proven to be a moving target; the Biden administration has yet again extended the PHE through early 2022, nearly two years after the majority of pandemic-related job losses occurred.

With Covid vaccines and treatments widely available and an abundance of good-paying jobs waiting to be filled, federal lawmakers must enact policies that encourage the able-bodied to go back to work. By winding down the FFCRA’s Medicaid expansion, they can end one big incentive for Americans to remain jobless and finally restore the ability of states to police their own Medicaid rolls, ensuring that those who are not eligible are removed to make room for those who are.