For millions of Americans who get medical care under Medicaid, the end of March marks a grim deadline. Starting April 1, states will start removing people from the government health insurance program for the poor, paring rolls that swelled during the pandemic. 

The government estimates that 15 million people — or  roughly 1 in 6 of the 84 million on Medicaid — will be kicked off the program. Here’s why this is happening and what people should know.

What’s happening to Medicaid? 

During the pandemic, the government suspended procedures that would remove people from Medicaid. Before the crisis, people would regularly lose their Medicaid coverage if they started making too much money to qualify for the program, or if they moved out of state or gained health care coverage through their employer. That stopped once COVID-19 hit, causing Medicaid enrollment to grow by 5 million between 2020 and 2022.

The Consolidated Appropriations Act, signed last December as the pandemic continued to ebb, instructed states to restart eligibility checks of every person currently on Medicaid. To stay on the rolls, individuals will have to fill out forms to verify their personal information, including their address, income and household size.

Who is affected?

People in danger of losing Medicaid coverage may have relocated or received an income boost that makes them ineligible. 

“Millions of people, working adults, parents with children, will lose Medicaid when they try to re-enroll,” said Ellen Taverna, associate director of the Together for Medicaid program at Community Catalyst. Of those, she estimated 380,000 are working adults who won’t be eligible for other health coverage because they make too little to qualify for Obamacare subsidies, while making too much to sign up for Medicaid. 

However, many are likely to drop out of the program for administrative reasons, such as not receiving a form they need to fill out to re-verify their income and eligibility.

When are people losing coverage? 

That depends on where you live in.

Some states have already started the disenrollment process. The Associated Press reported that no-longer-eligible Medicaid members could be removed as soon as April in these nine states: Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma and West Virginia.

But not all ineligible people will be dropped from the program at once, as states have set different timelines for re-checking eligibility of Medicaid patients. Most states are expected to take between nine months and a full year to complete the verification process.

How are states notifying people being about losing Medicaid?

As recently as December, two-thirds of adults in Medicaid households weren’t aware that the program rules were changing, according to a survey from the Robert Wood Johnson Foundation.

“Unfortunately we’re going to see it in real time, with children and people losing coverage simply because people are unaware of what’s happening,” Taverna said. 

“That’s the concern, that people will go without coverage for months and then go through bureaucracy and red tape to have to reenroll.” 

Health care advocates are urging people on Medicaid to update their contact information, including their home address, phone number and email, with the state.

If you rely on Medicaid, states will mail a renewal form to your home. The federal government also requires states to contact you in another way -– by phone, text message or email –- to remind you to fill out the form.

“A text might just grab someone’s attention in a way that would be more accessible,” said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors. 

While most states have already used texting for reminders to get a COVID-19 vaccine or attend an upcoming doctor’s visit, sending mass texts on Medicaid eligibility will be new, McEvoy said.

You will have at least 30 days to fill out the form. If you do not fill out the form, states will be able to remove you from Medicaid.

What options do people have if they lose Medicaid?

Some of those who won’t qualify for Medicaid coverage will be able to get health insurance from the  Affordable Care Act’s marketplace for coverage, where private coverage subsidized by federal tax credits can cost as little as $10 a month, depending on a person’s income. 

A special enrollment period for people dropped from Medicaid starts March 31 and will last through July 31, 2024, the Centers for Medicare and Medicaid Services said in January. People who lose Medicaid coverage can submit an application at any time during that period after losing coverage and will have up to 60 days to select their plans, CMS said. 

It noted that consumers don’t need to wait until their Medicaid ends to apply for new coverage, but can start applying 60 days before their Medicaid is scheduled to end. 

Still, coverage through the Obamacare marketplace or through an employer is often vastly different from what Medicaid offers. 

“Even on employer-sponsored plans, copays and out-of-pocket costs may be higher than Medicaid, and that makes it unaffordable,” Taverna said. 

People changing coverage will also need to check that their new insurance plans will still cover their doctors.

What happens to kids enrolled in Medicaid?

More than half of U.S. children receive health care coverage through Medicaid or the Children’s Health Insurance Program. But even if an adult loses Medicaid coverage, it doesn’t mean their kids will. 

Even if you receive a notice that you’re no longer eligible for Medicaid, it’s likely that your child still qualifies for the program or for health care coverage through CHIP. CHIP covers children whose families make too much money to qualify for Medicaid but don’t earn enough to afford private health insurance.

Between 80% and 90% of children will still be eligible for those programs, according to estimates from the Georgetown University Health Policy Institute’s Center for Children and Families.

“When a parent receives a message that they aren’t eligible anymore, they often assume their child is no longer eligible either,” Joan Alker, the center’s executive director, told the Associated Press. “It’s more common to find that the parent is no longer eligible for Medicaid, but the child still is.”

The Associated Press contributed reporting.