People line up outside an assisted living office in Missoula, Montana, on Oct. 27, 2023, to regain Medicaid coverage after being removed from the government’s insurance program for people with low incomes and disabilities. Before doors open at 8 a.m. on October 27, 2023. Each said they had experienced long waits on the state’s telephone helpline. (Catherine Houghton/KFF Health News)
In Montana, more than 20 people lined up outside the state assisted living office before it opened to avoid having their Medicaid coverage cut off.
Callers in Missouri and Florida reported being held on the hotline for more than two hours to renew their Medicaid coverage.
The parents of a disabled Tennessee man who has been on Medicaid for 30 years fought with the state this summer to keep him enrolled as he lay dying in the hospital with pneumonia.
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Seven months after what was predicted to be the biggest disruption in the 58-year history of the government’s health insurance program for people with low incomes and disabilities, states have cut eligibility for more than 28 million people. look over, Terminated compensation Over 10 million of them. Millions more people are expected to lose Medicaid in the coming months.
The unprecedented drop in enrollment came after federal protections that prohibited states from removing people from Medicaid during the three years of the pandemic ended this spring. Since March 2020, enrollment in Medicaid and related children’s health insurance programs has jumped by more than 22 million people, reaching 94 million.
The process of vetting the eligibility of all beneficiaries has not been a smooth one for many Medicaid enrollees. Some people lose coverage without knowing why. Some are struggling to prove they are still eligible. Beneficiaries and patient advocates claim Medicaid officials sent mandatory renewal forms to old addresses, miscalculated income levels and provided clumsy translations of documents. Attempts to process tens of millions of cases simultaneously also exacerbated long-standing weaknesses in the bureaucratic system. Some suspect that certain states have used this confusing system to block registration.
“It’s not just bad, it’s worse than people imagine.” Camille Richeux, director of health policy for the nonprofit organization Arkansas Advocates for Children and Families. “This round of mitigation was not about using all means to determine who is eligible, but how can we get people out using all means possible.”
Indeed, some Medicaid recipients who entered the program when the U.S. unemployment rate spiked during COVID-19 lockdowns have since returned to their pre-pandemic lows. Because of this, he is getting health insurance through his new job.
And some of those whose enrollments were canceled were enrolled in Affordable Care Act marketplace plans. For example, Centene CEO Sarah London told investors on October 24 that the company expects up to 2.4 million of its 15 million Medicaid managed care members to lose coverage due to the rollback. He said he expects more than 1 million customers are participating in the exchange. Plans from the same time last year.
Still, no one knows how many former Medicaid recipients remain uninsured. The state does not track what happens to all of them after they are expelled. And the final tally likely won’t be known until 2025, when the rollback ends by next summer and federal authorities examine Americans’ insurance status.
Without Medicaid, patients miss out on appointments.
Trish Chastain, 35, of Springfield, Missouri, said her Medicaid coverage is set to expire at the end of this year. Her children are still covered, but her income is too high at $22 an hour, which disqualifies her. Chastain’s employer, a rehabilitation center, provides health insurance, but her premiums cost $260 a month. “My monthly budget doesn’t allow for that,” she said.
she said she didn’t know her may be eligible Learn about low-cost plans in the Afforable Care Act Marketplace. However, it would still incur new costs for her.
Disparities in insurance coverage can jeopardize access to health care services and financial security when needed to pay for medical expenses that cannot be deferred.
“If you put off treatment of any kind, whether it’s asthma, autism, or something as simple as an earache, it can get worse if you wait,” said the Kansas City chairman. says pediatrician Pam Shaw. Committee on State Government Affairs of the American Academy of Pediatrics.
Physicians and community health center representatives across the country said they are seeing an increase in cancellations and no-shows among uninsured patients, including children.Nationwide, states have already canceled their registrations. at least 1.8 million children in 20 states Provide data by age. Because children typically qualify more easily than adults, child advocacy groups believe that many children are unfairly dismissed based on what their parents deem to be no longer eligible. Meanwhile, enrollment in CHIP, which has a higher income eligibility level than Medicaid, has only increased slightly.
The percentage of children disenrolled varies by state, ranging from 68% in Texas to 16% in Massachusetts, according to KFF. President Joe Biden’s administration said in September that most states were incorrectly administering eligibility tests and improperly canceling the enrollment of eligible children and household members.that ordered states to restore insurance coverage Approximately 500,000 people.
Different timetables, different dropout rates
One of the few states to complete the lifting in six months, as of September, 121,000 of the 153,000 beneficiaries reviewed had completed the state of relief due to the end of the public health emergency. The company announced that it had canceled its registration because it suspected that it was no longer eligible to receive benefits. Of the campaigns launched, about 13,600 people signed up for private coverage on the state’s ACA Marketplace, said Pat Kelly, the state’s executive director. your health idaho, State Exchange. State officials say they don’t know what happened to the rest.
California, by contrast, began cutting off benefits this summer and automatically transferring coverage from Medicaid to marketplace plans for those eligible.
Medicaid disenrollment rates among people surveyed so far vary widely by state, primarily along the blue-red political divide, from a low of 10% in Illinois to a high of 65% in Texas.
“I feel like the state of Illinois is doing everything they can to make sure as few people lose their insurance as possible,” Paula Campbell said. Illinois Primary Health Care Associationrepresenting dozens of community health centers.
Nationally, about 71% of Medicaid enrollees had their coverage terminated due to procedural problems, such as not responding to requests for information to confirm eligibility. It’s unclear how many people are actually still eligible.
State and local Medicaid officials said they have attempted to contact enrollees in a variety of ways to confirm eligibility, including letters, phone calls, emails and text messages. But some Medicaid recipients may not have a consistent address or internet service, may not speak English, or may be juggling more pressing needs.
“While the rollback effort remains extremely difficult, this is a significant step forward for all states,” said Kate McEvoy, executive director of the association. National Association of Medicaid Directors.
“People aren’t doing well.”
As a result, in many states, registrants are forced to wait long periods for renewal assistance. Missouri had the worst call wait times, according to a KFF Health News review of letters to the Centers for Medicare and Medicaid Services. sent to the state In August.inside Letter to Missouri’s Medicaid ProgramCMS says it is concerned that an average wait time of 48 minutes in May and a 44% call abandonment rate among Missourians are hindering “equitable access” to assistance and patients’ ability to maintain insurance coverage. Ta.
Sunni Johnson, a registrar for Affinia Healthcare, which operates community health centers in the St. Louis area, said some people have been waiting more than three hours. This is a big hurdle for many people who have limited talk time on their mobile phones.
More than 730,000 people in Florida have been removed from the program since April, and those who signed up earlier this year were forced to wait almost two and a half hours at a Spanish-language call center. report From civil rights organization UnidosUS. Jared Nordlund, UnidosUS’ Florida director, said Spanish-language versions of the Medicaid application, renewal websites and other communications are also causing confusion.
“They can hardly understand the Spanish translation accurately,” he said.
Miguel Nevarez, a spokesman for the Florida Department of Children and Families, which administers the state’s Medicaid redetermination process, said complaints of poor translation and long wait times at a Spanish-language call center are “false stories.” criticized. “The data clearly shows that Florida has implemented a fair and effective redetermination plan,” he said.
In California, he said, similarly, congested phone lines, crowded and understaffed county offices, and difficulties downloading renewal forms electronically “make it even more difficult to renew” Medicaid. skyler rosellini, senior attorney in the Los Angeles office of the National Health Law Program. “Based on the cases that we have, we know that people are not infected.”
Jasmine McClain, a 31-year-old medical assistant, said she tried everything until Montana ended Medicaid coverage for children ages 3 and 5 in early October. She tried to submit documentation online and by fax to prove they were still eligible. She was on hold for hours on the state hotline. After her children’s coverage ended, she went to the state welfare office in Missoula, but she couldn’t get an appointment. One day in mid-October, about 30 people lined up outside the office from 6:40 a.m. before the doors opened.
After three weeks of asking for help while the children were uninsured, the state reinstated the children’s insurance. She said her supervisor told her that the documents her family submitted online were initially not processed.
“The phone system was a mess. It took a week to get a callback just to talk to someone,” McClain said. “There were just a lot of hurdles to overcome.”
Spokespeople for Medicaid programs in Montana, Florida and Missouri all said their states have reduced call wait times.
Some Medicaid recipients are seeking help through the courts.in 2020 Class Action Lawsuit Against the State of Tennessee In response to the government’s proposal to suspend Medicaid eligibility screening, parents of beneficiaries testified that they spent hours on the phone and online with state Medicaid programs trying to avoid losing their children’s coverage. ing.
One of those parents, Donna Guyton, said in a court filing that Tennessee’s Medicaid program, TennCare, stopped covering her 37-year-old son, Patrick, who was eligible for Medicaid due to a disability, in June. He said he had sent a letter canceling the request. Guyton made phone calls and appeals to protect her son’s insurance, but she was hospitalized with pneumonia and died in late July after spending several weeks in the hospital.
“While Mr. Patrick was fighting for his life, TennCare was threatening to strip him of his health insurance and the services he relied on,” she said in a court filing. “We could have focused on Patrick’s care, but our family had to navigate a system that continued to deny him eligibility and put his health insurance at risk.”
TennCare said in a court filing that Patrick Guyton’s Medicaid coverage was never actually revoked and that the termination letter was sent to his family due to an “error.”
Phil Galewitz in Washington, DC wrote this article. Daniel Chan of Hollywood, Florida; Katherine Horton of Missoula, Montana; Brett Kellman of Nashville, Tennessee; Samantha Liss and Bram Sable Smith of St. Louis; Bernard J. Wolfson and Bernard J. Wolfson in Los Angeles contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs and an independent source of health policy research, polling and journalism.Click here for details KFF.
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