Medicaid: Unraveling, Expanding, Delayed - TribPapers

Medicaid: Unraveling, Expanding, Delayed

Photo by the National Cancer Institute.

Asheville – Something is sweeping the nation, and it’s called Medicaid unwinding. According to the North Carolina Department of Health and Human Services (NC DHHS), an estimated 300,000 qualified beneficiaries in the state may lose coverage because of it. A tally in August had already put the number of wrongly terminated beneficiaries identified by the state at 68,400.

It all started with COVID, though many would argue the problems began with Medicaid itself, or at least the way it’s managed. During the pandemic, the federal government suspended the requirement to re-enroll annually for continuous coverage. The provision only lasted three years, expiring this April.

Whereas during the pandemic, people were allowed to continue receiving Medicaid even if they no longer qualified; post-pandemic, qualified persons are being disenrolled merely for not having their paperwork completed. In most cases, the blame is falling on agencies and programs whose social workers either lacked the knowledge or the paperwork required to re-enroll beneficiaries.

While the mass disenrollment may have been an unintended consequence for those who set America up for it, it was not unforeseen. It’s just worse than predicted, according to Doug Sea at the Charlotte Center for Legal Advocacy (CCLA). He predicted the numbers could be double those given by the NC DHHS. The CCLA had been involved in a class action lawsuit against the state to prevent qualified individuals from being dropped merely because they didn’t get the memo about needing to resume annual re-enrollment.

Terms of the settlement now require the state to send out notices to people about to be disenrolled. Recipients are informed they have up to 60 days to appeal the action and 90 days to provide the information required for re-enrollment. In addition, people disenrolled because they were no longer eligible are being given an extension for enrolling in Obamacare.

As the NC DHHS goes through its rolls of beneficiaries, it is trying to contact its 2.5 million potential disenrollees during the month of their plan’s expiration date. This is easier said than done. Some beneficiaries are being automatically re-qualified if the necessary information, like income and household size, is available through other government databases. If not, the NC DHHS has been trying to contact people through multiple letters, emails, texts, and bot calls. It will even make one additional attempt to contact people after they have been disenrolled.

Some disenrollees do not respond because they know they do not qualify. Fewer than 3% of people not answering state contacts can be attributed to case workers failing to update contact information. A larger number have not responded because they are suspicious of the letters. They have not had to re-enroll for three years, and the questions certainly look like somebody’s phishing. Another reason is that people may not understand English. Some may not have the necessary technology, or they may not be literate in how to use it, and if they pick up the phone to call, a two-hour hold time would not be out of the ordinary. Then again, the poorest of the poor and those most in need of health benefits might be too ill or just too stressed to deal with bureaucratic paperwork.

During North Carolina’s first month of disenrolling, 8,637 people lost their benefits because they were no longer eligible, compared to 59,762 who had their plans canceled for what is now known as “procedural disenrollment. That put North Carolina in a tie with Connecticut for seventh place for the reported percentage, year-to-date, of disenrollees who are procedural. New Mexico leads the pack with a whopping 97%.

Thickening the plot, during the pandemic, Medicaid enrollment grew 36% to 797,000. Then, Governor Roy Cooper signed Medicaid expansion into law just five days before North Carolina’s April Fool’s Day launch of its unwinding plan. As if the NC DHHS hadn’t been hit with enough of a bureaucratic nightmare, Medicaid expansion cannot go into effect until the budget is passed.

In recent years, it has been a source of consternation for local governments and public schools that the North Carolina General Assembly cannot finalize its budget, upon which they are significantly reliant, until long after they are statutorily required to approve their budgets. This year is no different. As legislators continue to haggle, the October 1 launch date for Medicaid expansion has been declared infeasible. This has only fueled a movement to decouple Medicaid from the rest of the budget.

The expansion will reduce eligibility requirements for Medicaid, and it is expected to add 600,000 to the rolls. It didn’t go unnoticed that if the state had just passed the budget, the NC DHHS wouldn’t have had to disenroll the unqualified, who will thereby become requalified.