Medicaid unwinding plagued by error, confusion

WASHINGTON — Days after surgery and with a young son undergoing chemotherapy, Kyle McHenry was scrambling to find out whether his Florida family would still be covered by Medicaid on Monday.

A form on the state’s website said coverage was denied for their ailing 5-year-old son, Ryder. But another said the family would be on Medicaid for the next year. Still, a letter from the state said McHenry now makes too much money for him, his wife and their eldest son to qualify after the end of the month.

RELATED: A state-by-state look at the impact of Medicaid determinations

Three phone calls with Florida’s Department of Children and Families and a total of six frustrating hours later, McHenry finally got the answer he’s been wondering about on Thursday: Most families are losing Medicaid coverage, though Ryder was able to fight his illness. remain eligible due to ,

“I’m trying not to go into a panic,” McHenry’s wife, Ellie McHenry, told The Associated Press earlier in the week. The state agency did not respond to the AP’s request for comment.

The McHenrys are among the first casualties in an unprecedented nationwide review of 84 million Medicaid enrollees next year that will require states to remove people whose incomes are too high for the federal-state program now offered to the poorest Americans.

Millions of people are expected to remain without insurance during the coronavirus pandemic after getting relief for the past three years, when the federal government barred anyone deemed ineligible.

Advocacy groups have warned for months that the whole undertaking would be riddled with confusion and errors, unfairly leaving some of the country’s poorest people without health insurance and unable to pay for needed medical care.

Not a Modern Healthcare subscriber? Sign up today.

Medicaid enrollees are already reporting they’ve been kicked the wrong way in a handful of states that did, including Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire and South Dakota, according to data collected by the AP. Started removing people.

Trevor Hawkins is seeing the problems firsthand in Arkansas, where officials told the AP the state is moving “as quickly as possible” to complete a review before the end of the year.

Hawkins spends his days driving winding roads across the state providing free legal services to people who have lost coverage or need help filling out pages of forms sent to him by the state. In between his drives, he fields about a half-dozen phone calls daily from people seeking guidance on their Medicaid applications.

“The notices are very confusing,” said Hawkins, who works for Legal Aid of Arkansas. “No two people have had the same experience losing their coverage. It’s hard to identify exactly what the problem is.”

Some people have been mailed pre-application forms that include incorrect income or household information but leave no room for Medicaid enrollees to correct state errors. Hawkins said others have received documents that say Medicaid recipients will lose their coverage before they even have the opportunity to reapply. A spokeswoman for the Arkansas Department of Human Services said the forms instruct enrollees to fill out their information.

Tonya Moore, 49, went weeks without Medicaid coverage because the state used her 21-year-old daughter’s wages, including income from two part-time jobs that no longer worked, to determine whether she could qualify for the program. was ineligible for County officials told Moore that they had to obtain statements from the businesses — about an hour’s drive from Moore’s rural home in Highland, Arkansas — to prove that her daughter no longer worked there. Moore says she wasn’t able to get the documents before she was pulled from Medicaid on April 1.

Download Modern Healthcare’s app to stay informed when industry news breaks.

By last week, Moore had run out of the blood pressure medication and insulin used to control her diabetes and was staring at a nearly empty box of blood sugar test strips.

“I got a little nervous,” she said at the time. “I don’t know how long it’s going to take to get my insurance.”

With the help of legal aid, Moore was reinstated on Medicaid as of Monday.

The McHenry family in Winter Park, Florida, also worries that the state has combined their incomes when checking their eligibility for Medicaid.

After their son Ryder is diagnosed with cancer in September 2021, Allie McHenry quits her job to care for him, leaving the family with a single income from Kyle McHenry’s job as a heavy diesel mechanic Went. She then signed up the family for Medicaid, but says they were initially denied because the state incorrectly counted disability payments for Ryder’s cancer as income. He is concerned that the state has included those payments in its latest assessment, but has been unable to get a clear answer after calling the state three times and being disconnected twice on hold for hours.

Allie McHenry said of her attempts to reach the state helpline, “Trying to call them is always a nightmare.” “I don’t have the heart or the strength to try and call again.”

Notices sent to the McHenrys and reviewed by the AP show they were given less than two weeks’ warning that they would lose coverage in late April. The federal government requires states to tell people only 10 days before they will be dropped from Medicaid.

The family’s experience is not surprising. Last year, Congress, so concerned that some states were ill-equipped to properly handle the number of calls flooding the lines during the Medicaid process, made states submit data about their call volume, wait times and abandonment rates. needed to be done. A spokeswoman for the agency said the federal Centers for Medicare and Medicaid Services will try to work with states where call wait times are particularly high.

Some doctors and their staff are taking it upon themselves to inform patients about the complex process they’ll have to navigate for the next year.

Most of the younger patients are covered by Medicaid, says pediatrician Lisa Costello in Morgantown, West Virginia, and she’s made a point of chatting with parents about how the process will go. She is encouraging her colleagues to do the same. West Virginia officials have sent letters to about 20,000 people saying they will lose coverage on Monday.

Costello said some people may not realize they don’t have Medicaid until they fill a prescription or visit a doctor in the coming weeks.

“A lot of it is educating people, ‘You’re going to get this information; Don’t throw it away,'” she said. “How many of us receive a piece of mail and throw it in the trash because we think it’s not important?”

Each weekday, about a dozen employees from Adelante Healthcare, a small chain of community clinics in Phoenix, call families they believe are at risk of losing Medicaid. Colorful posters on the walls remind families, in both English and Spanish, to make sure their Medicaid insurance doesn’t expire.

Similarly, Alicia Celaya, a 37-year-old waitress in Phoenix, learned that she and her children, ages 4, 10 and 16, would lose coverage later this year.

When she and her husband were laid off from their jobs during the COVID-19 pandemic, she enrolled in Medicaid. Both have returned to work in the restaurant industry, but Celaya and her children remain on Medicaid for free health care coverage as she struggles to come up with the hundreds of dollars to pay the monthly premiums for her employer-sponsored health insurance. are unable.

The clinic is helping her navigate the private health insurance plans available through the Affordable Care Act’s Marketplace and is trying to determine if her children are covered by the federal children’s health insurance program known as KidsCare in Arizona. are eligible for. Celaya said she’ll never be able to figure out the market, where dozens of plans covering different doctors are offered at different price points

“I’m no expert on health insurance,” she said.

Source link

Leave a Comment