Medicaid Eligibility Changes Set to Hit Hospitals, Insurers, States

WASHINGTON—An unprecedented effort by states to review the eligibility of the more than 90 million people on Medicaid carries high financial stakes for industry groups, including hospitals that risk paying more to cover uninsured patients and insurers that could lose some of the money they get for managing state Medicaid programs.

Eligibility reviews for people who get Medicaid coverage were paused during the Covid-19 pandemic. The resumption of those reviews and disenrollment of people, technically starting Saturday, has industry working with federal regulators, patient advocacy groups and state Medicaid offices to urgently inform beneficiaries. All of them are working to tell enrollees what steps they can take to avoid losing coverage or how to secure other types of health insurance if they earn too much for the program.