Of the approximately 2 million Virginians enrolled in Medicaid before the COVID-19 pandemic, over 480,000 have been exmatriculated since August of this year.

Normally, eligibility decisions are made annually, but federal policy put them on hold nationwide during the pandemic. That changed last year, which is colloquially known as the “Medicaid wind-down” because the provisions of the federal law expired.

One of the main reasons people are excluded from Medicaid insurance is that they no longer meet the financial requirements for eligibility—for example, an income of 80 percent or less of the federal poverty level.

While the data on ineligibility might indicate higher incomes, which can be beneficial to people, policy analysts at the Commonwealth Institute point out that this is not always the case with health insurance coverage.

A financial exclusion from Medicaid does not always mean that someone otherwise has health insurance, explained TCI policy director Freddy Mejia.

Examples of this would be people who work multiple part-time jobs at the same time and thereby generate a combined income – which does not entail employer-sponsored insurance – or people who receive a temporary increase in income through seasonal work and are therefore no longer eligible for Medicaid.

There are also non-financial reasons for removal, such as Procedural problems such as failure to submit the correct documents for re-enrollment on time.

“We see many people canceling their Medicaid insurance, but we have no idea what happens to them,” Mejia said. “Future data will take some time to see who is uninsured and who is not after that.”

Medicaid is a state and federal program that provides insurance coverage to low-income people or those with disabilities. For some people, Medicaid or even employer-provided insurance may not be enough. For example, free clinics in Virginia have reported an increase in patient numbers in recent years.

Some of these patients are referred to as “ALICE patients,” i.e. working people with limited assets and income.

Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, said this demographic group contributed to the increase in patient numbers even before the pandemic.

“The crisis is hitting the middle class as we know it much harder,” he said.

The clinics across the state are a critical point of access to health care for some of Virginia’s poorest residents, as well as immigrant and refugee families. They are also a point of access for people caught between work and health insurance – the “safety net to the safety net,” Phillips said.

Meija noted that the number of uninsured people could continue to strain Virginia’s free clinics and state-qualified health centers, which may have to care for more people than their resources can support.

Meanwhile, about 69,000 people are still waiting for their Medicaid eligibility to be re-determined. A spokesperson for the Virginia Department of Medical Assistance Services said that number is a backlog of members who make up about 3% of the “total cohort that is winding down.”