Medicaid’s automatic enrollment provisions are unwinding due to the end of the COVID-19 public health emergency, which means D.C. residents are now expected to begin renewing their benefits on a monthly basis. As of June 2023, about 3,000 Medicaid beneficiaries in D.C. have been disenrolled, according to the D.C. Department of Healthcare Finance.

Nationally, more than 560,000 beneficiaries have been dropped from Medicaid, with a median disenrollment rate of 34.5 percent, according to a Kaiser Family Foundation analysis. D.C.’s disenrollment rate is high compared to other states with publicly available data because it has some of the highest eligibility rates in the country, according to DHCF.

As part of the Consolidated Appropriations Act, 2023, signed into law on December 29, 2022, Congress delinked the continuous enrollment provision from the public health emergency, ending continuous enrollment on March 31, 2023. Starting April 1, states could resume Medicaid disenrollments.

As a result of the unwinding of continuous enrollment provisions, millions of people are expected to lose coverage and that could reverse recent gains in coverage.

The Kaiser Family Foundation estimated that Medicaid and Children’s Health Insurance Program enrollment grew by 23.3 million to nearly 95 million from February 2020, at the beginning of the pandemic, to the end of March 2023, when the continuous enrollment provision ended. KFF expects that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.

Although continuous enrollment provisions are coming to a close, federally qualified health centers in the District have been using a variety of strategies to keep their residents enrolled with as little turmoil as possible. 

Health centers are community-based and patient organizations that provide affordable and accessible primary health services to individuals and families. Health centers help remove barriers such as cost, lack of insurance, distance, and language for their patients. There are 36 federally qualified health centers in D.C., three of which are operated by Mary’s Center and 19 of which are operated by Unity Health Care.

Mary’s Center, a health center that serves more than 65,000 individuals in D.C. and Maryland, works with three programs that support Medicaid applications and renewals: the Bilingual Health Access Program, DC Health Link, and PG Health Connect. 

“We are constantly campaigning to educate the community on the Medicaid enrollment provisions to reduce any gaps in coverage using all venues possible to make sure they don’t miss the deadline and these days we are doing an extra push so that our community members have this important health coverage,” Tara Pavao, the social services director at Mary’s Center, says in an interview with City Paper. 

In partnership with the D.C. Department of Human Services and the Mayor’s Office on Latino Affairs, BHAP assists participants with the process of applying for public benefits, including Medicaid. BHAP outreach workers provide guidance to participants throughout the application process and support Mary’s Center participants with gathering their necessary documents and help translate all necessary information. Lyda Vanegas, a spokesperson for Mary’s Center, tells City Paper that BHAP was one of the Center’s first programs and started to provide services in 1990. 

According to Vanegas, the program began to “help our immigrant patients coming for prenatal and pediatric care at that time to enroll in the services they were eligible for given their difficult circumstances. Since then, [BHAP has] been helping thousands of participants with insurance and other public benefits enrollment.”

D.C. Health Link is the health insurance marketplace for the District of Columbia, created pursuant to the Patient Protection and Affordable Care Act. On its website, residents can purchase insurance or find out how to apply for Medicaid. Prince George’s County Health Connect is a program that supports Medicaid renewals for county residents and helps them enroll in health insurance through Maryland’s state marketplace. 

According to the KFF, immigrants and people with limited English proficiency, people with disabilities, and older adults are at an increased risk of losing coverage or experiencing a gap in coverage due to barriers completing the renewal process, even if they remain eligible for coverage. Mary’s Center emphasizes its marketing campaign that works to keep participants informed about deadlines and gives them resources to help them with renewals. “All the communications have been translated in various languages to educate the community on Medicaid’s enrollment process,” Pavao says. 

At Unity Health Care, as of 2022, 62 percent of its more than 82,000 patients relied on Medicaid. As a result, they have developed ideas to make sure their residents don’t lose their benefits.

“Our health centers have signage alerting patients to the need to renew that includes a QR code connecting them to additional information from the Department of Health Care Finance,” a spokesperson from Unity Health Care wrote in a statement to City Paper.

When a resident’s Medicaid coverage is up for renewal, DHCF will also send a letter to the address the resident provided when they applied for health coverage.

Unity Health Care explained that “the application is significant” and in order to complete the process, patients must log in to the DistrictDirectDC website.

“We know many of our patients have barriers to accessing computers or have limited knowledge of using them,” the spokesperson from Unity Health Care wrote. To help, Unity Health Care is making team members and laptops available at their health centers so that patients can re-enroll with technological and physical support by their side.

According to the D.C. Department of Health Care Finance Eligibility Monitoring Dashboard, 306,242 D.C. residents are enrolled in Medicaid and 20,459 are enrolled in Alliance and Immigrant Children’s Programs as of June 2023. 

According to Pavao, Mary’s Center supported a total of 1,266 D.C. residents with Medicaid, Alliance and ICP applications and renewals from January to April 2023. Although they haven’t experienced any Medicaid delays, the group has experienced ICP delays beyond the 45-day DHS timeline. DHS has 45 days to process ICP applications before recipients lose their benefits.

According to its statement to City Paper, in 2023, Unity’s social services team has completed approximately 1,000 encounters so far with patients regarding insurance enrollment and Unity’s insurance specialist completed around 540 face-to-face insurance visits. 

“We know that applications submitted with assistance from the social services team have had lower rates of rejection and our ongoing partnership with the Ombudsman Office has supported improved processing time for applications,” the spokesperson wrote. “This important work will continue throughout the full re enrollment period.”

This story has been updated with figures on D.C.’s Medicaid disenrollment.