Too many Americans are losing Medicaid coverage because of red tape, and states should do more to make sure eligible people keep their health insurance, the Biden administration said Monday.

More than one million Americans have lost coverage through the Low-Income and Disabled Americans program in recent weeks, following the end of pandemic protections on April 1, according to the latest Medicaid renewal data from more than 20 states.

After a three-year hiatus, most states have now started checking which Medicaid recipients are eligible again and are dropping those who are no longer eligible or don’t complete required paperwork. About 4 in 5 people who have fallen to date never returned paperwork or omitted required documents, federal and state records show.

Xavier Becerra, secretary of the Department of Health and Human Services, denounced those numbers in a letter to state governors at

June 12 Monday

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I am deeply concerned about the number of people who are needlessly losing coverage, especially those who appear to have lost coverage for preventable reasons that the state’s Medicaid agencies may prevent or reduce, he wrote.

Medi-Cal will soon end some people’s benefits. What this means for you

The Biden administration outlined several optional steps states can take to ensure that anyone still eligible for the safety net health insurance program remains covered. For example, states can pause cancellations to allow more time to reach people who haven’t responded. Health insurers that manage Medicaid plans can help their enrollees fill out the paperwork.

Some states have already opted to take extra time. Although Wyoming began renewals in May, the state is deliberately cautious and won’t drop people due to incomplete paperwork until July or August, said Kim Deti, spokesman for the health department. Oregon won’t begin those cancellations until October.

Officials in other states have shown no eagerness to delay the cuts.

About 10% of Arkansas Medicaid and Children’s Health Insurance Program enrollees have already been dropped, almost all of them because they failed to complete paperwork. Arkansas is speeding up redeployments in just six months, while most other states take about a year, as recommended by HHS. Despite outcry from some federal lawmakers and attorneys, Medicaid officials in the state wrote on June 8 that they would continue to quickly unenroll people who no longer qualify.

That could be disastrous, says Joan Alker, executive director of Georgetown University’s Center for Children and Families.

My big concern is that we could lose millions of families quickly,” she said. “It will be very difficult to get them back.

Stopping the Attrition: California and other states want to guarantee Medicaid for children

Becerra also wrote that he is particularly concerned about the loss of coverage by children, although the administration is not sure how many children were dropped. States are not required to report age-by-age numbers to federal authorities, said Dan Tsai, director of the Center for Medicaid and CHIP Services.

According to data from states that shared it, tens of thousands of children are losing coverage. In Indiana, one-third of the 53,000 dropped off in the first month were children. In South Dakota, more than half were children. In Arkansas, nearly 55,000 children were dropped in the first two months.

Becerra also urged governors to work more directly with families at risk of losing coverage. State agencies should work with schools, faith-based groups, pharmacies and other community organizations to help enrollees better understand how to stay on Medicaid, he wrote.

‘A perfect storm’: Patients trying to hold Medi-Cal wait a long time for help

In most states, people who still qualify for Medicaid but lose coverage because of state errors or incomplete paperwork have 90 days to reclaim their coverage.

Some officials see the high number of paperwork-related cancellations as not a problem, as people can reapply if they still qualify. But it’s not that simple, Alker said. Many people are unaware of their appeal rights, and the grace period does not apply to all adults in several of the hardest-hit states.

Alker said states will temporarily save money because they won’t have to pay for enrollee care. But in the meantime, people can’t afford their regular medicines. Some will end up in the emergency room sicker than before, she said. Nothing good really comes out of these gaps in coverage.

This article was produced by

KFF Health News

formerly known as Kaiser Health News, a national newsroom producing in-depth journalism on health issues.