DAILY TRIFECTA: And The Meek Shall Inherit The Dearth
It's A Hand Off, Not A Hand Up
TITLE: Half a million people, including kids, mistakenly dropped from Medicaid
EXCERPT: As a result of the glitch, families have been flagged as ineligible for Medicaid coverage even if a kid or other household member should still be individually eligible. Adults in most states that have expanded Medicaid qualify for the program if they make up to 138 percent of the federal poverty level while kids can still be eligible at up to 200 or 300 percent, depending on where they live.
The system errors identified by CMS led to children in at least 18 states and Washington, D.C., losing coverage, while adult household members with different eligibility statuses lost coverage in another 22 states. Some had both issues, and 23 states and territories had neither.
Daniel Tsai, deputy administrator and director of the Center for Medicaid & CHIP Services at CMS, said the agency doesn’t know how many of the 500,000 who lost coverage were kids, though it anticipates they represent a “significant portion.”
TITLE: Helpers few and far between for rural Americans kicked off Medicaid after pandemic
EXCERPT: Having navigators to provide in-person help in rural communities is an ongoing challenge nationwide, said Alker, a co-author of Georgetown's Center Children and Families brief. But the end of pandemic protections is an especially important moment for navigators and the role they play in guiding people through complex insurance processes, she said.
This became clear following a recent survey that looked at what consumers encountered when they independently searched for health coverage on Google. “The results are really concerning,” said survey co-author JoAnn Volk, the founder and co-director of the Georgetown University Center on Health Insurance Reforms.
The researchers found that former Medicaid enrollees looking for health plans on the private market face aggressive, misleading marketing of limited-benefit products that don’t cover important services and fail to protect consumers from high health costs.
Researchers tried shopping for coverage using two profiles of consumers who were losing Medicaid coverage and were eligible for a plan with no premiums or deductibles on the ACA marketplace.
The team reported that none of 20 sales representatives who responded to their queries mentioned no-premium, no-deductible plan, and more than half pushed limited-benefit products. The representatives also made false and misleading statements about the plans they were touting and misrepresented the availability or affordability of the marketplace plans.
The sales reps and brokers quoted limited plans that cost $200 to $300 a month, Volk said. Such an expense could prove unaffordable for consumers who may still have low incomes despite being ineligible for Medicaid.
“If they can’t get to a navigator, I would not trust that they would get to their best coverage option in the marketplace, or to the marketplace at all, frankly,” Volk said.
TITLE: She has Medicare and Medicaid. So why should it take 18 months to get a wheelchair?
EXCERPT: "Duals" are forced to navigate both of the country's two largest public health insurance programs, Medicare and Medicaid, to get the care they need.
Each program plays critical and fundamentally different roles for this population.
Medicare, which covers people 65 and older and those with disabilities, tends to pay for urgent medical needs like surgeries and hospital stays. Medicaid, the program for those with low incomes, typically picks up longer term services like regular home visits from an aide.
But there are plenty of gray areas. Knowing what service is covered by which program and when can easily devolve into a Kafkaesque nightmare.
Many of the people stuck traversing what is arguably U.S. health care's most infuriating maze are among the country's sickest, costliest and poorest patients.
About one-third have a serious mental illness. Around two-thirds have at least three chronic medical conditions. Roughly nine out of 10 people enrolled in these two programs live on less than $20,000 a year.
Together, Medicare and Medicaid spent nearly $450 billion in 2019 on these patients. Yet many, like Render-Hornsby, still struggle to get the care they need.
"The federal taxpayer is spending trillions of dollars for incredibly bad outcomes," says Republican Sen. Bill Cassidy of Louisiana, who's leading a bipartisan effort to address this issue.