More than 350,000 people may lose Medicaid coverage once the COVID-19 public health emergency ends early next year, as is expected. The projections have grown as the public health emergency has been extended and more have enrolled — with a peak of 1.75 million people on the program now projected for mid-2023.

In Tennessee, the Medicaid program TennCare has gone through periods in which years go by without reassessing the financial situations of families. The process known as “redetermination” was paused in 2014 as the Affordable Care Act began, and TennCare grew by a similar figure. Many never received the paperwork they needed to stay enrolled.

“We had thousands of clients who reached out to us in the context of this. Many of them had never moved. They didn’t get the packet. So we’re very concerned,” says Michele Johnson, executive director of the Tennessee Justice Center. The TJC has ongoing litigation against TennCare over families who lost coverage.

Many of the 350,000 added since the pandemic began will have their first experience with redetermination. Many may have seen their financial circumstances improve and no longer qualify for coverage. But others could get lost in the paperwork shuffle, Johnson says.

As has happened previously, children are expected to face the brunt of any bureaucratic hangups. They represent the bulk of people covered by TennCare. Often, they can get coverage even if their parents don’t qualify. But the process is an ordeal, says Dr. Jason Yaun, a pediatrician in Memphis.

“The application is daunting, even for people with high levels of health literacy,” says Yaun, who leads the state chapter of the American Academy of Pediatrics.

TennCare is warning people to watch the mail. The agency has also set up an “unwinding” website.

“It’s imperative that our members update their contact information and respond to all communication that they receive from TennCare,” director Stephen Smith said at his budget hearing with Gov. Bill Lee. “We want all eligible members to remain eligible. But eligibility is dependent upon providing the necessary information to TennCare.”