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Bureaucratic failure is no reason to purge Medicaid rolls - The Washington Post [1]

['Catherine Rampell']

Date: 2023-06-01

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A government letter sent to an out-of-date address. An exhausted mother unable to make it to the social services office before the deadline. A non-native-English speaker having difficulty with a janky state website. Wp Get the full experience. Choose your plan ArrowRight So far, these kinds of bureaucratic snafus appear to be the primary reason millions of Americans are losing Medicaid coverage this year and next.

Starting April 1, states around the country began disenrolling people en masse from Medicaid. This is the result of the end of a temporary, covid-era rule that required states to keep existing Medicaid beneficiaries on their books; in 2020, exchange for extra Medicaid funding, states had to err on the side of preserving access to health care during a pandemic. The public health emergency is over, though, and states can now revert to whatever renewal or termination policies they had pre-covid.

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Even if those policies were pretty lousy at making sure people eligible for insurance actually receive it. And they often are.

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Across the 11 states that have reported data already, more than half a million Medicaid enrollees have lost their coverage since April 1. In Florida alone, the number is nearly 250,000, according to data from the Kaiser Family Foundation.

Here’s where the numbers get especially infuriating. States are supposed to break out how many people lost coverage because they were reassessed for eligibility and actually determined to no longer qualify (because their income rose, for example, or they aged out of the children’s health insurance program) versus how many people lost coverage for pointless “procedural” reasons (e.g., the state never received documentation needed to reassess eligibility).

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Based on the states that have publicly released breakdowns so far, the majority of people losing Medicaid are casualties of those paperwork-related reasons.

We don’t yet know how many of the people losing Medicaid can or ultimately will be re-enrolled in coverage. Most states are not actively tracking these kinds of outcomes. And unfortunately a lot of Americans may not even recognize that they need to reapply for public insurance until it’s too late.

“Many people don’t realize that they’ve been disenrolled from Medicaid until they show up at the pharmacy to get their prescription refilled or they have a doctor’s appointment scheduled,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

People in this situation are allowed to reapply for Medicaid, but the process can be cumbersome and slow. Despite federal laws requiring speedy adjudication of Medicaid applications, in some states (such as Missouri and Texas) applications often take over 45 days to process. Even if their renewal applications are ultimately successful, low-income patients may need to put off access to medications or other necessary care.

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The early data available on disenrollments thus far, from just those 11 states, is a sliver of the population expected to fall victim to this Medicaid purge.

The Congressional Budget Office recently forecast that 15.5 million people who remained on Medicaid because of special pandemic-era policies will be kicked off their coverage by late 2024. For scale, that’s roughly 20 percent of total Medicaid enrollment.

About one-third of the population expected to be purged are children, a group that until recently had been making major strides in securing access to health care.

Some of the Americans losing Medicaid will likely get different forms of insurance — for example through the individual marketplace or an employer. More than 6 million are projected to become uninsured entirely, according to the CBO.

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As covid-era Medicaid provisions unwind, millions will become uninsured Forecasts for health-coverage transitions over 18 months, beginning April 2023 Leaving Medicaid after eligibility redetermination 15.5 6.2 Uninsured million people million Not transitioning 61.1 Nongroup coverage 1.6 Employment-based coverage, newly obtained 3.2 4.6 Employment-based coverage, previously simultaneous with Medicaid Source: Congressional Budget Office, HealthAffairs. As covid-era Medicaid provisions unwind, millions will become uninsured Forecasts for health-coverage transitions over 18 months, beginning April 2023 Leaving Medicaid after eligibility redetermination 15.5 6.2 Uninsured million million people Not transitioning 61.1 1.6 Nongroup coverage 3.2 Employment-based coverage, newly obtained Employment-based coverage, previously simultaneous with Medicaid 4.6 Source: Congressional Budget Office, HealthAffairs. As covid-era Medicaid provisions unwind, millions will become uninsured Forecasts for health-coverage transitions over 18 months, beginning April 2023 Leaving Medicaid after eligibility redetermination 15.5 6.2 Uninsured million people million Not transitioning 61.1 1.6 Nongroup coverage 3.2 Employment-based coverage, newly obtained Employment-based coverage, previously simultaneous with Medicaid 4.6 Source: Congressional Budget Office, HealthAffairs.

In any other rich country, government failure at this scale would be considered embarrassing. U.S. states already have internal records — through payroll taxes, among other things — that could be used to determine who qualifies for critical benefits. Instead the burden of proof is usually placed on poor people, and benefit-eligible families and children fall through the cracks.

To be clear, such dysfunction and administrative “churn” are not new; Americans have simply taken them for granted. Perhaps the silver lining of the purge is that with so many people affected at once, this large-scale government incompetence might become more conspicuous. Maybe at last the public will demand better.

This long-term problem requires a long-term solution: investing in state administrative capacity. At the very least, more states should step back and assess why so many of their residents are losing health coverage. Idaho, to its credit, recently paused its “procedural” Medicaid cancellations, citing an unspecified “technical” challenge. Iowa says it added a “safety check” to its Medicaid redetermination process, requiring a case worker to manually review materials before disenrolling households that haven’t returned renewal forms.

Alas, not all states seem motivated to ensure their own residents get the critical services they are promised — and owed.

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[1] Url: https://www.washingtonpost.com/opinions/2023/06/01/medicaid-purge-covid-insurance-government-bureaucracy/

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