The Biden administration is calling on state officials to slow down reviews of their Medicaid programs that have already reduced enrollment by more than 1 million nationwide and will likely reduce it by several million more in the months to come.

The worry is that many of the people losing Medicaid still qualify under the programs guidelines, are struggling with cumbersome paperwork requirements and will end up uninsured although nobody knows for sure how many of the people losing coverage fall into that category or what will happen to each of them as a result.

All of this is happening because of a pandemic-era policy that is expiring.

Under the terms of COVID-19 relief legislation that Congress passed and former President Donald Trump signed in early 2020, the federal government offered states extra money to administer Medicaid, the program that provides health insurance to low-income Americans. In exchange for the bump in funds, states agreed to suspend their usual processes for reviewing Medicaid enrollment so that, in most cases, anybody who joined or was already on the program got to stay on it.

Now that arrangement is ending. The federal government is ratcheting back its Medicaid funding contribution to the usual, pre-pandemic levels. States, in turn, are resuming their eligibility checks a process that will inevitably cause many people to lose the Medicaid coverage they currently have.

But some states are undertaking these reviews more quickly and aggressively than others.

Officials in those states , most of them Republicans, say they are simply taking responsible steps to manage a program that got too big and too expensive during the pandemic and that now covers too many people who no longer meet the programs criteria for enrollment.