Lifting Administrative Burdens to Advance Health and Racial Equity

By Suzanne Wikle 

Medicaid is one of the most valuable parts of our country’s health system and safety net. It provides affordable health care to nearly one in four people, including almost half of all children. People of color are disproportionately insured by Medicaid due to several systemic issues over generations that lead to more people of color working in jobs with low wages and without health benefits. A new paper released today by CLASP and the Center on Budget and Policy Priorities (CBPP) details the racist roots of administrative burdens in Medicaid, describes how these burdens continue to harm eligible people – particularly people of color—and provides specific recommendations for states to reduce administrative burden as a key strategy for advancing racial equity in Medicaid. 

Policymakers and advocates have rightfully centered a great deal of effort in the past decade on expanding eligibility in all states. However, we also need to ensure that those who are eligible can enroll and stay enrolled with ease. To achieve this goal we must reduce and eliminate administrative burdens, which disproportionately hamper people of color from enrolling in Medicaid. Two-thirds of people who are eligible for Medicaid but not enrolled are people of color. Discussions about health equity, reducing disparate outcomes, and access to affordable coverage must focus on the experience of eligible people, including the barriers they face to accessing coverage for which they are eligible.  

Some level of administrative burden is inherent to means-tested programs that require people to prove their eligibility. But programs are too often designed to weed people out rather than ensure they receive the health care, food assistance, or other help they need. While Medicaid has made progress on eliminating administrative burdens, particularly with Affordable Care Act provisions such as the elimination of asset limits for most recipients, there is still much work to be done.  

Advocates and state administrators can use this new report to help identify areas where their state is preventing eligible people from accessing Medicaid due to administrative roadblocks. Medicaid programs vary greatly between states, including their administrative processes and burdens. For example, some states have adopted 12-month continuous eligibility, while others terminate coverage if recipients fail to respond to mailings. Even when federal law requires practices – such as using existing data to try to renew enrollment before requiring people to fill out forms – states vary greatly in their implementation. Federal policymakers should explore what leverage they have to ensure states adopt this paper’s recommendations. Beyond the report’s recommendations, CLASP will continue to advocate for all people to have access to affordable health care. 

>> Read the report