Advocates are accusing the Biden administration of failing to address the alarming number of Americans being removed from the Medicaid program. Reports suggest that up to 30 million individuals, primarily from impoverished backgrounds, could lose their Medicaid coverage due to error-riddled state reviews. The Avalere health consulting firm has projected these numbers as states undertake a comprehensive re-evaluation of the program’s 94 million enrollees. Concerns have been raised over a range of problems encountered in different states, including long wait times on helplines, confusing government forms, and wrongful termination of coverage for children.
One Arkansas-based attorney, Trevor Hawkins, who assisted individuals with Medicaid eligibility, voiced his frustrations with the process, highlighting issues with erroneous forms that instructed people to reapply for Medicaid instead of renewing their existing coverage. Despite raising concerns with the Centers for Medicare and Medicaid Services (CMS), no action was taken. Advocates across the country have reported widespread problems, with some fearing that systemic issues are being ignored.
Congress lifted a policy that prohibited states from terminating Medicaid coverage during the pandemic, instead requiring them to review eligibility for each enrollee within a year. However, the Democratic-led Congress also bestowed upon Health and Human Services Secretary Xavier Becerra the authority to penalize states or suspend disenrollments if individuals were improperly removed. Little information has been provided by the Health and Human Services (HHS) department regarding the problems it has identified. While HHS briefly halted disenrollments in 14 states, the specific states and reasons behind the pause were not disclosed. In August, HHS revealed that thousands of children had been wrongly removed from coverage in 29 states. CMS compelled these states to reinstate coverage for those affected.
Stories of individual struggles have emerged throughout the nation. Lily Mezquita in Florida, a working mother, experienced two unsuccessful attempts at removal from Medicaid during her pregnancy despite being entitled to coverage. It took 17 phone calls, with wait times of up to two hours, before her coverage was reinstated. Due to delays in reinstatement, Mezquita had to pay for prescribed medication out of pocket and missed follow-up appointments for her baby.
According to Avalere’s projections, as many as 30 million individuals could be dropped from Medicaid once states complete their eligibility reviews, which greatly surpasses the Biden administration’s initial estimate of 15 million. The majority of terminations have been due to procedural issues such as failure to submit renewal forms or provide necessary paperwork. This highlights broader problems with how states determine Medicaid eligibility, ranging from inadequate communication and confusing notices to excessive documentation requirements. Many of those removed for these procedural reasons may still qualify for Medicaid.
The scale of issues faced in Arkansas became evident in public records obtained by the Associated Press. Over 70% of individuals in the state lost Medicaid coverage due to failure to make contact, non-return of renewal forms, or non-submission of requested documents. Numerous emergency room visitors in Arkansas discovered they had no coverage. While the state’s Department of Human Services insists it made every effort to reach people through additional calls, emails, and texts, critics argue that Arkansas should have been subject to intervention by CMS.
Florida and North Carolina have dealt with their own set of challenges, including long wait times, confusing notices, and difficulty making contact by phone. Texas experienced website and app failures that prevented families from receiving electronic notices regarding Medicaid coverage renewal. In Texas, almost 1 million individuals lost Medicaid coverage, prompting some lawmakers to call for a CMS investigation.
CMS has held meetings with advocacy organizations to address the issues, but in some cases, the problems raised do not violate federal regulations. The CMS has preferred to work cooperatively with states on Medicaid enrollment improvements. However, there is growing consensus among advocates that it may be time for CMS to adopt a more enforcement-oriented approach.
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