“We never got anything telling us to recertify,” said one Florida resident whose children lost coverage. “We never got anything saying we were booted out of the system.”

A healthcare catastrophe is unfolding across the U.S. as states—now unrestrained by coverage rules enacted early in the coronavirus pandemic—continue to remove people from Medicaid at an alarming clip, mostly for procedural reasons unrelated to their eligibility for the program.

The Kaiser Family Foundation (KFF), which has been tracking Medicaid disenrollments since Congress and the Biden White House agreed late last year to begin unwinding pandemic-era coverage protections in April, estimates based on state data that more than 1.2 million people have been removed from the program in 21 states as of Thursday.

KFF found that in the states with available numbers, “76% of all people disenrolled had their coverage terminated for procedural reasons.” Such disenrollments, KFF noted, “can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe.”

Eligibility checks and renewal procedures, which vary by state, are a bureaucratic maze in which many are bound to get lost.

In Republican-led Florida, the state with the most disenrollments thus far at close to 250,000, some residents say they’ve been removed from Medicaid without receiving any notice from the government, finding out about their lack of coverage only when they attempted to schedule a doctor’s appointment or pick up a prescription.

“We never got anything telling us to recertify,” said one Florida resident whose children recently lost their Medicaid coverage. “We never got anything saying we were booted out of the system.”

Similar reports are emerging from Arkansas, where Republican Gov. Sarah Huckabee Sanders is publicly bragging about the pace of her state’s Medicaid purge. Federal guidance gives states up to 14 months to complete their Medicaid eligibility screenings, which were paused during the coronavirus pandemic to limit coverage disruptions.

But Sanders has pledged to finish the process in half that time—and many are falling through the cracks as a result.

More than 110,000 thousand Arkansans have lost Medicaid since April, the third-largest disenrollment total in the country behind Florida and Arizona, according to data compiled by KFF.

Politicoreported earlier this week that “seven in 10 Arkansans who have lost their insurance have been dropped for procedural or administrative reasons,” meaning “the government hasn’t determined someone makes too much money to qualify for Medicaid, but rather that the person failed to respond to a letter or provide extra information to renew their coverage.”

“In some cases, people are losing coverage because of system glitches,” the outlet added. “What’s happening in Arkansas is unique in its speed but the state’s early efforts are a cautionary tale for the roughly 93 million Americans on Medicaid who are expected to go through the renewal process during the next year.”

“These numbers are staggering and suggest excessively high rates of denials on procedural grounds that could severely harm access to care for children.”

Despite the worrying statistics and anecdotes, the Biden administration has declined to intervene or criticize the Medicaid redetermination process of any specific state.

Earlier this week, Health and Human Services Secretary Xavier Becerra sent a letter to the governor of every U.S. state expressing concern over the “high number of people losing coverage due to administrative processes” and reminding officials that they “must comply with federal rules regarding how they conduct” Medicaid renewals, including affording due process to those kicked off the program.

Becerra sent the letter after Rep. Frank Pallone (D-N.J.) and Sen. Ron Wyden (D-Ore.) implored federal health officials to “ensure states are held accountable for complying with federal law, and step in to protect vulnerable populations from being improperly disenrolled from Medicaid.”

“We urge you to move swiftly to use these tools to prevent more coverage losses among eligible children and adults in Florida, Arkansas, and other states,” the lawmakers wrote, citing a ” disturbing report” that “described a family of a five-year-old with cancer spending hours on the phone with Florida’s Medicaid agency to determine if their son had lost coverage after the website indicated he had.”

“In the first month of redeterminations in Florida, over half of the people whose eligibility was checked were terminated,” wrote Pallone and Wyden. “Over 80% were for procedural reasons and most are likely to be children and parents given that Florida has not expanded Medicaid to adults. These numbers are staggering and suggest excessively high rates of denials on procedural grounds that could severely harm access to care for children.”

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