Up to 16 million Americans on Medicaid, the federal-state program that provides health care to low-income people, are on the verge of calamity, and it will take thoughtful, decisive action on the part of government to warn it.
In the early days of the Covid-19 pandemic, as part of the Families First Coronavirus Response Act, the federal government increased its share of Medicaid reimbursement to states. In exchange, states agreed to not remove anyone from Medicaid. This protection, and the expanded reimbursement, were to stay in place until the federal government ended the pandemic public health emergency.
This piece of legislation did a great service. It ensured that low-income people, including those with disabilities, had continuous care and coverage at a time of great health turmoil. When the federal government ends the public health emergency — a date has not yet been announced — the enhanced federal funding stops three months later.
The federal government is calling on states to implement the change gradually over a year’s time so that people who become ineligible can be seamlessly transferred to a subsidized insurance program that states run through their health exchanges.
The reality is that the change will be anything but orderly. In some states, like Arkansas, the transition will be worse than others because they have passed laws for a quicker unwinding process. In all states, vulnerable people who rely on Medicaid — and who qualify for it — will lose their coverage. The result will be that people will go without vital medications and miss necessary medical visits and procedures. Some, tragically, will die, not because they made too much money to be covered by Medicaid but because they could not navigate the renewal.
My colleagues and I have worked with people on Medicaid for several decades, helping them through the “redetermination” process. It may be the most complex government application process in existence and, ironically, it is undertaken by a population that is the least able to see it through.
The process is comprised of myriad verifications and complex formulas. The people applying are often desperate for help. Many don’t speak English. Some have behavioral health conditions, substance use disorders, or other disabilities. Some lack a permanent address and can’t get mail.
When people fall off Medicaid because they are unable to comply with redetermination, they end up uninsured. They lose out on care they need and, when they get back on Medicaid their needs are more acute because they are sicker.
Here are four things that can be done to warn this disaster:
States should tune up databases now. Rather than waiting for the change to roll out, states can get their affairs in order now. They can go through lists of members to update contact information and be sure they have a way to communicate with members who will need to go through the process, including those experiencing homelessness.
Leverage community groups and providers. No one is better suited to do outreach to Medicaid members than the community, church, and civic groups that work with low-income populations, as well as the physicians, health centers, and hospitals that already care for them. These groups should be given grants to work with Medicaid members to help them navigate this process.
Establish help centers. State Medicaid agencies should create statewide help centers where they can provide face-to-face support to people undergoing the redetermination process. In much the same way that states provide taxpayers with assistance near the filing deadline, so too states should create help centers in public libraries and city and town halls to provide one-to-one assistance navigating the process. Call centers are great, but historically these hubs tend to get overwhelmed with calls.
Maximize discretion. Governments proved their ability to be flexible, to pivot, and to adapt during the pandemic. The question for many government programs became not “Do you qualify?” but rather “How can we help?” This has been one of government’s finest hours. It will be important to not flip a switch and go back to the way things were the instant the public health emergency ends.
It is in everyone’s best interest to get the redetermination process right, as the cost of treating people in hospital emergency departments will be far greater than ensuring that people continue to get primary care. More importantly, though, it’s crucial that they keep receiving the care and coverage they deserve.
Gerard A. Vitti is the founder and CEO of Healthcare Financial Inc., a Boston-area company that works with health plans to assist individuals in obtaining health care benefits.