Medicaid Unwinding – Pushing Policymakers to Protect Families

Disparate Impact of Medicaid “Unwinding”

This analysis finds that, across a 10-state sample, state policy and administrative decisions resulted in nearly 1.4 million excess Medicaid disenrollments in counties where immigrants account for larger shares of county population. This disparate impact has health equity, as well as health outcome, consequences.

As as states return to periodic Medicaid eligibility redetermination, federal and state policymakers must act on the brief’s recommendations to address known coverage barriers facing immigrant families.

Documenting Major Gaps in States Medicaid Unwinding Performance that Threaten Immigrants and their Family Members

This report includes the findings from a September 14 to October 16, 2023 survey of state advocates and community based organizations in 28 states. PIF found major gaps in how their states were addressing immigrant concerns, providing language access, publicly reporting data and engaging stakeholders in the unwinding renewal process. The report provides states with grades for their performance on each of these approaches.

Letter Urging the Center for Medicare & Medicaid Services (CMS) to Hold States Accountable for Improving Medicaid Renewals for Immigrants and their Family Members

40 Members of the Protecting Immigrant Families Coalition’s Steering Committee and Medicaid Unwinding Task Force signed this letter urging CMS to pause Medicaid “unwinding” in states that are out of compliance with federal law and policies. Medicaid eligibility determination processes in these states fail to address known barriers that could lead to eligible people in immigrant families losing Medicaid coverage. The letter asks CMS to use its authority to ensure that states:

• Do not request social security numbers and immigration status when it violates federal policy;
• Communicate renewal messages that address public charge and immigrant-related fears;
• Improve compliance with federal language access laws; and
• Report more specific data

Attached to the letter is a memo with more detailed asks and justifications.

Press Release

Webinar Slideshow

PIF held a webinar with more than 300 participants in December 2023, walking through survey findings and recommendations for state and federal officials. Partners from Kansas, Massachusetts, and Tennessee also shared the Medicaid unwinding experiences of immigrant families in their states.

Survey of Spanish-Speakers

In addition to the survey of state advocates, PIF worked to ensure community voices were included in the discussion of how states are conducting their re-enrollment process. In order to get a community view, PIF partnered with UnidosUS, the nation’s largest Hispanic civil rights and advocacy organization and Noticias Para Inmigrantes (NPI), a media and communications organization with an audience of approximately 5 million US-based, Limited English-Proficient Latinos of all immigration statuses including naturalized citizens, to survey Medicaid recipients about their experiences with the re-enrollment process.

The survey found that 2 / 3 knew little or nothing about the Medicaid re-enrollment process, a majority had heard mis-information about Medicaid, and many had persistent fears about public charge and immigration. The survey report provides recommendations for states to improve their engagement efforts with immigrant families to ensure they do not lose coverage unnecessarily.