Eight months after states began dropping millions of low-income families from Medicaid rolls, grassroots groups say it’s leading to people denied coverage for bureaucratic reasons.
Nationwide, more than 12.5 million people have lost coverage since April. At that time, the federal pandemic rule that had required states not to leave anyone off the rolls ended and states restarted eligibility checks.
Over the summer, federal officials gave states flexibility to avoid potentially unnecessary coverage losses, sending letters to governors warning that large numbers of procedural moves and long wait times could violate federal rules.
Still, 13.12. by 71% of those left out lost their security due to procedures, i.e. they lacked papers or otherwise did not complete the renewal process by a certain date, according to the health policy research organization KFF.
Many of them may be eligible for insurance coverage, but they struggle to get the paperwork through the government bureaucracy.
Children, young adults, and blacks and Hispanics are overrepresented on Medicaid rolls compared to their share of the general population. In August 2022, the federal Office of Health Policy, released before the dismantling, estimated that nearly a third of those who would lose coverage would be Hispanic and 15 percent would be black, with health disparities widening during the pandemic. About 60% of Medicaid enrollees are black, Hispanic, Asian, or multiracial.
More than 2.4 million children have lost protection. On Monday, the U.S. Department of Health and Human Services issued a new warning and sent letters to the governors of the nine states with the most children dropped off the list: Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas. .
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Officials urged states that have reduced the number of children who lose Medicaid coverage to 60 percent nationwide to take advantage of flexibility offered by federal officials to prevent children and their families from losing coverage because of red tape. The measures are particularly important for children and families. color.
The agency also noted that the 10 states that have not expanded Medicaid—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming—have left more children behind than those that have expanded combined.
Federal officials also announced that relaxed rules allowing automatic renewals would be extended until the end of 2024 to give states more time and to protect more families.
States have published online tools to help local leaders and providers provide guidance on enrollment. For example, Texas created ambassador toolkits in Spanish and English with social media graphics and flyers to guide families and older residents from creating an online account to re-enrollment. Utah said it has developed billboard and radio ads, as well as its own toolkits and flyers in 13 languages.
Still, grassroots groups say they’re doing the heavy lifting.
These advocacy efforts go beyond the capital’s walls, said Dr. Dena Hubbard, a neonatologist at Children’s Mercy Hospital in Kansas City who chairs the American Academy of Pediatrics’ Kansas Chapter’s Committee on Public Policy.
[Theyre] going to people, meeting people where they are in their communities, knowing what they need, knowing where they are and helping them get the services they need, he said. I feel strongly that the grassroots position is there.
Frustrated and nervous
Karina Gonzalez’s 18-year-old son has just enough psychiatric medication to see him through the end of December.
The Kansas City, Kansas, mother of four is worried about what will happen next. Her family dropped Medicaid coverage in October, and the children haven’t been able to see a doctor, she said.
The Gonzalez household relies on the income of her husband, who works in the construction industry.
It has affected us, Gonzalez said in Spanish as her 16-year-old daughter translated. She said she gets frustrated and nervous, especially during flu season.
In the first week of October, Gonzalez received a letter saying the family was no longer covered. She said she didn’t know why they were dropped and struggled with the KanCare online system, which is not available in Spanish. That’s when she contacted El Centro, a community health advocacy group that helps Kansas Latino families. She said Spanish-speaking patient navigators there have helped her collect and submit documents for re-enrollment.
Matt Lara, chief of staff for the Kansas Department of Health and Environment, said that in addition to the online portal, applicants and reforming families whose first language is not English can call and connect with a language helpline.
“Kansas is not a Medicaid Expansion state, which means our eligibility threshold for non-disabled, non-pregnant adults is incredibly low,” Lara said in an emailed statement about losing coverage for children. “As a result, over 2/3 of our enrollees are children, resulting in them being the largest group of disqualified members.”
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In Utah, Oreta Tupola is the program coordinator for the Utah Community Health Workers Association. Health workers in her community have helped families in the Latino and Pacific Islander community reapply.
Families have called her from the emergency room after getting their relatives there and finding out they no longer have coverage. Many of his community health workers’ clients suffer from diabetes, high blood pressure and heart disease and are on essential medications.
We started getting calls from our customers now that I went to the doctor or the emergency room and I can’t get in. They don’t meet me, Tupola said. [Theyd say] I didn’t know I didn’t have coverage. Or one of the women who called me said, Hey, I’m trying to go get my medicine and when I went to get my medicine I found out I don’t have Medicaid anymore. Now efforts were made to get them back and approved, which is another long process.
Many of those who lost Medicaid coverage can get it. Utah has the second highest rate of administrative or paperwork lost at 94%, behind New Mexico at 95%.
New Mexicos Health Services Department told Stateline in an email that it is using multilingual awareness campaigns in conjunction with some federal regulations, such as a 30-day delay in closing procedures, which extends the renewal deadline. As a result, the department claims to see few eligibility closures.
Health policy experts weighed in last week in two columns published in the monthly peer-reviewed health care journal Health Affairs.
It should no longer be acceptable to maintain policies and practices that make it harder for people to enroll and maintain coverage, wrote experts at the Center on Budget and Policy Priorities, a research and policy institute that advocates for left-leaning policies. They said the process has shed light on the nation’s fragmented healthcare system.
Allison Orris, co-author and senior research fellow at the center, said in an interview that the continuous enrollment period demonstrated the benefits of minimizing red tape on a larger scale.
The turnover adds some challenges that have always existed in the systems, he said. The pandemic really exposed a lot of fractures in a lot of social service programs, and in Medicaid, we know that there’s always been a large number of people in Medicaid who were eligible for Medicaid but didn’t sign up, and that’s probably a sign that it was too difficult. to sign up and stay involved.
Craig Wilson, director of health policy at the Arkansas Center for Health Improvement, contributed to the second column. Georgetown University’s Center on Children and Families reports that Arkansas has the largest number of rural children covered by Medicaid. About 59% of Medicaid enrollees lost coverage in Arkansas.
Many of them may not have had contact with a Medicaid office for three or more years.
Craig Wilson, director of health policy at the Arkansas Center for Health Improvement
Wilson calls for a multi-state evaluation to compare states’ eligibility redefinitions, who was most affected geographically and demographically, and where and where they found other coverage or fell into coverage gaps.
There are some opportunities to learn from what happened that can be applied in future situations, especially in at-risk communities, he told Stateline. If there are states that did some things differently and were more precise in identifying either eligible or ineligible individuals and getting them to go in the right direction.
According to KFF, in Arkansas, 77 percent of Medicaid dropouts lost their coverage for procedural reasons, while 23 percent dropped out because they were deemed ineligible. Children make up more than a third of those who lost coverage in Arkansas.
Meanwhile, about 71% of Arkansans who renewed coverage retained coverage through a federal rule that allows states to use previous income data.
Children without shelter
According to KFF’s analysis, in the 21 states that reported coverage losses by age group, 2.4 million, or 40 percent, of those who dropped out were children.
After Texas at 61%, Gonzalezs Kansas ranks second among 21 states in the percentage of children who have lost shelter (55%), followed by Idaho (48%), Missouri (47%), Alaska (43%) and Minnesota (42%). %).
Massachusetts had the lowest percentage of children with an education at 18% of the 21 states, followed by California at 21%. Some states, such as North Carolina and Kentucky, keep children with pending renewals covered for another year while the states work on eligibility redefinitions.
But experts like Wilson worry that the lack of communication from state Medicaid offices for another year will cause more confusion about coverage.
Many of them may not have had contact with a Medicaid office for three or more years, he said. With a fairly transient population, it becomes a much bigger problem when the eligibility period is much longer.
For now, some grassroots groups rely on public outreach, such as putting up flyers and tables at community events.
Tupola, of the Utah Community Health Workers Association, said she hopes state Medicaid offices will support those on the ground like her organization, especially after national attention has been focused on the benefits of grassroots vaccination campaigns throughout the pandemic.
I think we will never be invited to the table until the numbers are high, people die or people lose coverage, he said.
You have to bring us in from the beginning.
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