The Biden administration is urging states to ensure that they aren’t wrongly terminating Medicaid beneficiaries as they rapidly drop people from the program that many with disabilities rely on.

In a letter this week to governors across the nation, U.S. Secretary of Health and Human Services Xavier Becerra implored states to use every tool at their disposal to keep people who should qualify from losing coverage.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that state Medicaid offices have the power to prevent or mitigate,” Becerra wrote. “Given the high number of people losing coverage due to administrative processes, I urge you to review your state’s currently elected flexibilities and consider going further to take up existing and new policy options that we have offered to protect eligible individuals and families from procedural termination.”

Under the public health emergency enacted in the early days of the COVID-19 pandemic, states were eligible for extra federal dollars for Medicaid if they agreed not to drop most people from the program. Now, however, with the end of the public health emergency in May, states are working to re-evaluate eligibility for everyone on Medicaid for the first time in years.

Already, states have disenrolled more than a million Medicaid beneficiaries, according to data from KFF, a nonprofit that conducts health policy research. In many cases, people are being cut off because they didn’t complete the renewal process, KFF found, with so-called “procedural disenrollments” accounting for as many as 89% of Medicaid terminations in some states.

“These aren’t people who were carefully reviewed and found ineligible; they’re people who weren’t able to complete a paperwork requirement. This suggests a rushed process that didn’t do enough to try and reach the most vulnerable beneficiaries, including our community,” said Zoe Gross, director of advocacy at the Autistic Self Advocacy Network. “We are concerned that many people who have lost their Medicaid coverage may not even know it yet. If they missed notices and paperwork about renewal, for example, if those were sent to an old or incorrect address, they may not realize that they had to complete paperwork, and may not find out they’ve lost coverage until they seek medical care and are denied.”

Becerra outlined a number of steps that states can take to make sure that eligible beneficiaries don’t unnecessarily lose coverage including spreading out the renewal process over a full year and automatically renewing individuals who qualify for programs like the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families. In addition, Becerra recommended working with managed care plans and using data from the U.S. Postal Service to update people’s contact information, among other strategies.

Further, Becerra warned that his agency will use its oversight authority to request that states pause procedural terminations “should it be needed.”

In the meantime, David Goldfarb, director of policy at The Arc, said that people with developmental disabilities can contact their state Medicaid office to find out when and how they will be notified about the renewal process. And, they should be diligent about checking for any mail or email from their state Medicaid office and responding accordingly.

Goldfarb said people with disabilities should also make sure that they are in compliance with their state’s rules about how much money they can earn or save while receiving Medicaid.

“And remember, you can request a fair hearing if you believe the state has wrongly determined you ineligible,” Goldfarb said.

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