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In March 2020, Congress passed a law that allowed states to receive extra federal funding for Medicaid on the condition that they not remove any recipients during the COVID-19 public health emergency. Former President Donald Trump signed the act into law.
President Joe Biden extended the pandemic health emergency several times, effectively barring states from removing Medicaid recipients. Once removals resumed, he also urged states to slow the evaluation process to ensure that people weren’t improperly removed.
Nikki Haley’s claim that "20 million" people were ineligible for Medicaid is based on estimates of how many could have been affected once removals restarted. But that doesn’t mean they weren’t eligible when they signed up, or that all are ineligible now. Evaluations of their eligibility continue.
Republican presidential candidate Nikki Haley criticized President Joe Biden about entitlement program enrollment and claimed he’s responsible for adding millions of ineligible recipients to Medicaid.
"Under Joe Biden, we now have more than 42 million people on food stamps and nearly 100 million people on Medicaid. That’s almost a third of the country. Biden sees that as an accomplishment," the former South Carolina governor and United Nations ambassador told a New Hampshire crowd Sept. 22. "He actually blocked states from moving people from welfare to work. And he put 20 million people on Medicaid who aren’t even eligible, then stopped states from taking them off."
For this fact-check, we’ll focus on the claim that Biden added 20 million ineligible people to Medicaid and stopped states from taking them off.
The number of Medicaid participants reached record highs during the COVID-19 pandemic because of a provision in a 2020 law that stopped states from removing enrollees.
Biden extended the pandemic health emergency several times, which also extended the provision. But former President Donald Trump enacted the law, not Biden.
Haley’s claim that 20 million are ineligible for Medicaid is inaccurate, experts told us. It’s based on estimates of how many people could have been removed once removals were permitted.
The figure includes people who could be deemed ineligible because of procedural issues, such as failing to turn in or update paperwork. That sometimes occurs when states have outdated enrollee contact information or when enrollees don’t understand how to complete renewal packets within the allotted time frame.
"The notion that this was President Biden’s doing is certainly a big lie and a radical oversimplification on the amount of people being ineligible," said Leigh Ku, director of George Washington University’s Center for Health Policy Research. "How many are ineligible is yet to be determined; they are still being processed. It’s a huge undertaking in the states and they are slowly working through those claseloads."
When contacted for comment, Haley’s campaign pointed to data showing that Medicaid rolls have ballooned since the pandemic’s onset and referred to reports that estimated around 18 million people would lose coverage by the end of the removal process. Neither is evidence that Biden is responsible for adding millions of ineligible people to the program.
In March 2020, during Trump’s presidency, Congress passed the "Families First Coronavirus Response Act." It included a policy that let states receive extra federal funds for Medicaid if they didn’t remove anyone from the program during the public health emergency. The provision is called continuous enrollment.
During the health emergency’s three-year duration, people were not removed from state programs unless they voluntarily withdrew or moved out of state. During continuous enrollment, Medicaid enrollment grew from 71 million in February 2020 to 94 million in April 2023.
In Congress’ fiscal year 2023 budget, the continuous enrollment provision was no longer linked to the public health emergency and ended April 1. Since then, states have resumed what is typically an annual process of reevaluating enrollees, removing those who don’t meet Medicaid’s requirements.
The Biden administration extended the public health emergency several times before it ended May 11. Concerned that large numbers of people would lose health care coverage, and that moving too quickly could incorrectly disqualify would-be Medicaid recipients, the administration urged states to slow down their reviews.
This concern proved prescient in September, when the federal government found that about half a million people — including a significant number of children — in 29 states had been improperly removed because of computer errors. Their coverage was restored.
States recently started reevaluating their Medicaid rolls, and it’s not yet clear how many people will be removed. Even if that number reaches or exceeds Haley’s 20 million figure, that doesn’t mean those people weren’t eligible when they signed up.
"They were technically all eligible because the law extended their eligibility,," Ku said. "Some of them would normally have fallen off eligibility because they got a job, or because they may have aged out of Medicaid or simply because they forgot to turn in their paperwork — that's one of the major things that happens is people forget."
As of Oct. 2, around 13.2 million of the 94 million enrollees have had coverage renewed, while 7.8 million were removed, according to KFF. KFF found that around 73% of the people removed from Medicaid were for procedural reasons, not necessarily because they were no longer eligible.
Haley claimed Biden "put 20 million people on Medicaid who aren’t even eligible, then stopped states from taking them off."
A 2020 law included a policy that let states receive extra federal money for Medicaid if they didn’t remove any enrollees during the COVID-19 public health emergency. That was signed into law by Trump, not Biden.
Haley’s claim that "20 million" are ineligible is based on the large number of people added to Medicaid during the pandemic, and some estimates of how many could be removed during reevaluations. But that doesn’t mean they weren’t eligible when they signed up, or that all are ineligible now. And some will be deemed ineligible for reasons such as failing to turn in paperwork.
States are still reevaluating their Medicaid rolls and available data shows that, so far, about 7.8 million people have been removed. But most were taken off the rolls because of procedural errors, such as paperwork discrepancies, not because they didn’t meet eligibility requirements.
We rate this claim False.
C-SPAN, Nikki Haley Gives Economic Speech in New Hampshire, Sept. 22, 2023
Congress.gov, FAMILIES FIRST CORONAVIRUS RESPONSE ACT
The New York Times, Here’s What’s in Congress’s Emergency Coronavirus Bill, March 14, 2020
Medicaid.gov, June 2023 Medicaid & CHIP Enrollment Data Highlights, Accessed Oct. 4, 2023
Medicaid.gov, Medicaid and CHIP Renewals: Returning to Regular Operations, Accessed Oct. 4, 2023
Urban Institute, The Impact of the COVID-19 Public Health Emergency Expiration on All Types of Health Coverage, Dec. 5, 2022
Congress.gov, H.R.2617 - Consolidated Appropriations Act, 2023, December 2022
Centers for Medicare & Medicaid Services, CMS Takes Action to Protect Health Care Coverage for Children and Families, Aug. 30, 2023
Centers for Medicare & Medicaid Services, Coverage for Half a Million Children and Families Will Be Reinstated Thanks to HHS’ Swift Action, Sept. 21, 2023
ABC News, Medicaid coverage restored to about a half-million people after computer errors, Sept. 21, 2023
KFF, Medicaid Enrollment and Unwinding Tracker, updated Oct. 2, 2023
Assistant Secretary for Planning and Evaluation, Medicaid Enrollees Who are Employed: Implications for Unwinding the Medicaid Continuous Enrollment Provision, April 2023
Phone interview, Leighton Ku professor and director of the Center for Health Policy Research at George Washington University’s Milken Institute School of Public Health, Sept. 25, 2023
Email interview, Benjamin Sommers professor of medicine and health policy & economics at Harvard T. H. Chan School of Public Health, Sept. 26, 2023
Email interview, Ken Farnaso spokesperson for Nikki Haley’s campaign, Sept. 26; Oct. 5, 2023
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