I Lost Medicaid—Now What?

Medicaid is the largest payer for health care in the United States, covering more than 90 million people—that is one in four Americans. While reliant on federal funding, coverage and qualifications change from state-to-state and can change when major funding changes happen at the federal level. What does this mean for people who rely on Medicaid—especially people with diabetes?

What is Medicaid?

In the land of privatized health insurance, Medicaid is a beacon of hope for many and a robust social safety net that keeps millions of people alive. Most of the people covered by Medicaid are low-income populations—this includes children, seniors, pregnant individuals and people with disabilities like diabetes.

Medicaid works like any other insurance plan, except there are no monthly premiums, no yearly deductibles and there are rarely co-payments for medicines like insulin or emergency room visits.

Medicaid is jointly funded and administered in partnership between the federal government and states. So each state’s Medicaid program can be run completely differently from the next, and they also can have different eligibility requirements.

Under the 2010 Patient Protection and Affordable Care Act, 39 states (plus the District of Columbia) have expanded and implemented income eligibility for individuals to qualify for Medicaid, which varies by state and is a percentage of the federal poverty level (FPL). Income eligibility can be determined as often as monthly, so there are a lot of people who typically fall off and back on, especially if their income is variable.

Losing health insurance can be devastating for someone living with a chronic illness like diabetes. It means that when you show up at the pharmacy counter to get your insulin, it’s no longer covered. It means that shipments of continuous glucose monitor (CGM) supplies to your home every month abruptly stop.

Losing health insurance without a backup plan means you can no longer see your endocrinologist, or any doctor at all, for that matter. For people living with diabetes, it spells disaster for most and certain death for some.

What to do if you’ve lost Medicaid coverage

If you lose Medicaid coverage, do not panic. There are options to ensure continuity of care for your diabetes management.

Since losing Medicaid coverage is a “qualifying event”, you can seek new health insurance at any time and you do not have to wait for open enrollment to begin on November 1st.

The following are ways to ensure you can get health insurance quickly:

• Ask your employer if they offer insurance (if they do, sign up ASAP, and coverage will usually begin on the first of the following month).
• Buy your own health insurance on the marketplace (which offers heavy subsidies for middle-income people).
• If you think you’ve been wrongly disenrolled, you can re-apply for your state’s Medicaid program to see if you are still eligible.
• If you’re under the age of 26 and recently lost Medicaid coverage, you can access health insurance on your parent’s health insurance plans.
• Additionally, if you’re married and your spouse has health insurance through their employer, you qualify for coverage under their insurance, too. Check with your spouse’s employer for eligibility requirements (proof of domestic partnership or marriage, etc.) and costs associated with coverage, which may be higher than if you carried your own insurance.
• If you need help affording your insulin, visit getinsulin.org for resources on accessing insulin quickly.

While you wait to regain insurance coverage, check out our resources for getting assistance with your diabetes management supplies.