FALLING THROUGH THE CRACKS — It’s been dubbed the Great Medicaid Unwinding. It may become the Great Medicaid Falling-Between-the-Cracks. During the pandemic Public Health Emergency, which was lifted this month, Medicaid enrollment reached about 95 million people and states couldn’t kick them off. Now, states have begun what will be a year-long process of notifying people — tens of millions of low income people — who may no longer be eligible for the federal-state health care program for low income people. Millions of people could become uninsured — including nearly seven million who are actually still qualified for Medicaid, according to the Biden administration’s own 2022 projections. Kids and minority groups will be disproportionately impacted. And given that states’ records on Medicaid outreach and enrollment is inconsistent, health care providers, particularly community health clinics and “safety net” hospitals that have a high share of low-income patients, will have to step up. Most people currently on Medicaid will still be eligible — if they get through the notification and recertification process. Others will be eligible for heavily-subsidized plans on the Affordable Care Act markets, or may get covered at work. In fact, almost everybody will be eligible for something — except those who fall in the “Medicaid gap,” in the 10 states still resisting Obamacare’s Medicaid expansion. (Two other states have approved expansion although it hasn’t kicked in yet.) But health care is difficult to navigate. Understanding the Medicaid unwinding, figuring out what you are eligible for and then actually getting signed up are three different things, each with its own complexities. “These are low-income people whose lives are often unstable and chaotic,” said Larry Levitt, executive vice president of the Kaiser Family Foundation. “Even in the most proactive states, many people will fall through the cracks.” Georgetown University’s Center for Children and Families is tracking how states are doing — from how well their consumer call systems respond to how transparent they are on their data. Gaps are already emerging. So a lot of the work is on the ground, one patient at a time. There are complicated rules about precisely who can help which patients actually enroll in which program. But all providers can help people understand what’s going on and point them in the right direction. Insurers, including those with Medicaid Managed Care plans, have an incentive to enroll people too. Some hospitals and clinics have planned for this — although it’s too early to know how well the plans they’ve drawn up are going to work as unwinding unfolds in the real world. “The key messages [to patients] have been 1. update your contact information with the state Medicaid agency 2. check your mail for your renewal form from your state Medicaid agency and 3. complete your renewal form,” Ted Henson, who leads an outreach and enrollment collaborative at the National Association of Community Health Centers, emailed Nightly. As many will need help with that, health centers have more than 4,000 “enrollment eligibility assisters” who can collaborate with everyone from administrative staff at the front desk to the doctors and nurses to help patients avoid pitfalls. Safety net hospitals are also stepping up. The Eskenazi Health system in the Indianapolis area, for instance, has been preparing for months and its assistance program has been underway since April 1, James Wager, the operation manager for patient access, told us. Eskenazi is considered an “authorized representative,” so it will get notified when someone in its system is being “unwound.” They can jump into action — including getting a translation service on the phone as needed. The Medicaid forms usually come in English and Spanish; that doesn’t cut it for the immigrant communities that speak, say, Burmese or Haitian Creole. They can help file the income verification — and guide someone to the ACA or job-related coverage if that’s where they belong. Redetermination is normally fairly routine — but it hasn’t happened now for three years, and to some people who are new to Medicaid, it’s particularly confusing. “We are trying to inform them that this is the new normal. Or the old normal,” he said. But since it’s not so normal — or easy — for many people, Eskenazi has put in extra layers from community outreach to email reminders through electronic medical records. Not all hospitals and clinics are so well-prepared. Some clinics are already reporting an uptick in appointment cancellations, which may mean people think they are now uninsured and are postponing care. Some who are eligible for Obamacare have heard a decade of scare stories about how it’s unaffordable — and a lot less clear messaging about subsidies and assistance, particularly for the lower income brackets. Some may not understand that if they are eligible for private or ACA insurance, they can get it now through a “special enrollment period” and don’t have to wait for the usual autumn open enrollment season. Ultimately, it’s up to states to make sure that message gets through. Federal health officials call it “administrative churn” when someone loses Medicaid even if they are still eligible. But in plain English, it means more poor people who are uninsured. As Indiana shows, there’s a lot that can be done right. But there’s also a lot that can go wrong. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author on Twitter at @JoanneKenen.
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