Medicaid, the federal-state entitlement for the poor, now provides health insurance to more than one in four Americans. Enrollments surged after the Affordable Care Act (ACA) was implemented, declined in 2018 and 2019, then jumped during the pandemic by about a third, or more than 23 million people. The reason for the surge was not increased poverty leading to new enrollments but rather a statutory ban on states’ use of Medicaid’s redetermination process to remove ineligible recipients. That ban has now been lifted, but advocacy groups worry that some people might lose government coverage and be forced to reapply or get private insurance; they worry less about how the government is spending tens of billions on ineligible beneficiaries.
Congress’s March 2020 Covid relief package—the Families First Coronavirus Response Act—temporarily raised the federal government’s share of total Medicaid costs by 6.2 percent but prohibited states that accepted the extra federal money from redetermining Medicaid eligibility and removing ineligible people from the rolls until the public-health emergency ended. Unsurprisingly, states took the extra cash, and enrollment swelled due to the continuous-enrollment requirement.