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As many as 18 million Americans may soon lose coverage and not realize it

MARY LOUISE KELLY, HOST:

As many as 18 million Americans could lose their health insurance over the coming months, and many don't even realize it. That is because a federal rule that protected people's Medicaid coverage during the pandemic expires at the end of March. NPR's Maria Godoy reports.

MARIA GODOY, BYLINE: Before the pandemic, people often got dropped from Medicaid, not just when they were no longer eligible but because keeping your coverage involves a lot of red tape. It's a big hassle. So when Congress passed a law back in 2020 that barred states from dropping Medicaid recipients, Kathryn Bamberger of Southeast HealthCare in Ohio says that was a relief for many low-income people.

KATHRYN BAMBERGER: That's been really huge because you don't want to find out that you don't have your Medicaid when you're in the emergency room and especially during a pandemic.

GODOY: But that protection expires March 31, which means people will once again have to provide documentation to stay on Medicaid. Stephanie Jorgensen is a 33-year-old single mother of two in Columbus, Ohio. She says the process can be incredibly frustrating.

STEPHANIE JORGENSEN: Gathering all of the verifications is, like, the most stressful part. It's a job.

GODOY: She spent much of her career working in social services nonprofits.

JORGENSEN: I'm like the encyclopedia of social services to a lot of my friends.

GODOY: Jorgenson is also on Medicaid, and she says even with all her expertise, it's a ton of work to navigate the system.

JORGENSEN: I have a master's, and it's still, like, a fight every step of the way.

GODOY: For example, she has to provide documentation that she no longer works at a nonprofit job she left more than a decade ago. That nonprofit doesn't even exist anymore.

JORGENSEN: So I can't even get a verification from them stating that, you know, they don't exist.

GODOY: Still, Jorgensen is relatively lucky. At least she knows she has to renew her Medicaid soon. A recent survey from the Urban Institute found that, nationwide, the majority of Americans enrolled in Medicaid don't know they'll need to act to keep their coverage. Kathryn Bamberger of Southeast Healthcare says the reality is many people won't realize they've lost Medicaid coverage until they actually need it.

BAMBERGER: We fully expect in April for people to call us from the pharmacy. That's often where they learn that, oh, my Medicaid doesn't work.

GODOY: Ohio has already started sending out renewal packets. At least 200,000 people in the state are expected to lose coverage starting in April. But that's just the people who will no longer be eligible. Many others who are eligible will nonetheless be dropped from Medicaid because the state can't reach them.

BAMBERGER: You've got a disproportionate number of people here who are not computer literate and whose housing is unstable.

GODOY: Many people have moved since the last time they had to renew their Medicaid three years ago, so they may not get their renewal notice. Samuel Camacho is a health insurance navigator with the Universal Health Care Action Network of Ohio. He says language is another major barrier.

SAMUEL CAMACHO: Most individuals are going to be vulnerable because of their lack of English. So they may receive a letter, but they can't read it.

GODOY: Camacho helps Spanish speakers in the Columbus, Ohio, region with their Medicaid paperwork. He says the process has gotten much harder because the local Medicaid offices have been closed to the public since the pandemic.

CAMACHO: Before the pandemic, individuals were able to go to the offices with an interpreter and have conversations with their case managers, print documents, find documents in their language, have interactions with people, even other Medicaid recipients. We've lost that.

GODOY: And he says that kind of word of mouth is really important for his community.

CAMACHO: Latinos, we're a group that thrives on communication (speaking Spanish). So we're losing that.

GODOY: Nowadays, Camacho helps Spanish speakers, often mothers, with Medicaid enrollment over the phone or at public libraries. He says the process generally takes two hours, but that's just the start of it. He says he often has to interpret when the state sends requests for more documentation.

CAMACHO: You know, the bill that you send was under your husband's name, but it needs to be under both of your names, little details. And if those details are not taken care of, you're denied.

GODOY: He says in his experience, those denials happen more often than not. And even though they're usually overturned on appeal...

CAMACHO: It's the heartache of having to do it again and again and again. It makes no sense.

GODOY: As frustrating as it can be, Camacho says he wants to make sure people on Medicaid know this. (Speaking Spanish). Everyone on Medicaid will have to reenroll. Maria Godoy, NPR News. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Maria Godoy is a senior science and health editor and correspondent with NPR News. Her reporting can be heard across NPR's news shows and podcasts. She is also one of the hosts of NPR's Life Kit.