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Since Congress called an end to several pandemic-relief policies last year, state Medicaid agencies like TennCare have been doing something that wasn’t allowed for years: dropping members who no longer qualify.

Tennessee has reviewed about half of the 1.7 million people enrolled in the low- and no-cost health program, agency officials told a House committee last week. About 43% of them maintained their TennCare coverage. Many of the people who lost their coverage did so because they began making enough money to be referred to the Affordable Care Act coverage exchange instead.

Medicaid members across the country can disqualify for several reasons. They can start making too much money, for example. Because Tennessee hasn’t accepted Medicaid expansion, the income caps are much lower. And in non-expansion states, most adults have to be parents or caretakers to qualify, and if they lose that status, they can lose eligibility. Children who qualify for TennCare coverage lose eligibility when they get too old.

“It’s a process that, absent extreme circumstances, is required every year,” TennCare commissioner Stephen Smith told the House Finance, Ways and Means Committee last week. “And we are prohibited from maintaining enrollment for any individual that does not verify eligibility. As we all are well aware, we had one of those extreme circumstances occur in 2020.”

The federal government forbid states’ Medicaid agencies from doing those checks or dropping anyone. Enrollment shot up by about 25% during the height of the pandemic, Smith said. It peaked in the middle of 2023.

“We have more than 1.7 million members that are going through this renewal process for the first time in three years, and we have some TennCare members that are going through this process for the first time since they’ve joined the TennCare program,” he said.

Compared to the rest of the country, Tennessee is so far pretty middle of the road on how many people stopped qualifying — about one of every three. Texas, which took the top spot, dropped members at twice the rate, according to a report by the Kaiser Family Foundation.

Nationwide, at least 14.3 million Medicaid enrollees have been disenrolled as of Jan. 9, according to the same report. They found that some states are doing what Tennessee is: checking members on their renewal date, same as usual. Others, such as Texas and South Carolina, targeted early checks on people who are likely to lose enrollment.

Of the Tennesseans who lost coverage, about 50,000 have been referred to the ACA exchange in the state.

According to recent federal data, about half a million Tennesseans enrolled in insurance through that program for 2024.