Medicaid Recipients Wrestle To Keep Enrolled

Medicaid — the state-federal medical insurance program for low-income and disabled People — has minimize greater than 22 million recipients since spring 2023.

One among them was the son of Ashley Eades. Her household misplaced their Medicaid protection within the “unwinding” of protections that had barred states from dropping individuals for years through the covid pandemic.

Many households, together with Ashley’s, nonetheless qualify for Medicaid however misplaced it for “procedural causes.” Principally, lacking paperwork.

The unwinding course of has been messy.

On this episode, host Dan Weissmann talks with Ashley in regards to the months she spent combating to get her son reenrolled in 2023 to get an on-the-ground have a look at how the unwinding is affecting households.

Then, Dan hears from workers on the Tennessee Justice Heart, Joan Alker of Georgetown College’s Heart for Kids and Households, and KFF Well being Information correspondent Brett Kelman, who has been overlaying Medicaid in Tennessee for years.

Dan Weissmann

@danweissmann

Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought of, Market, the BBC, 99 % Invisible, and Reveal, from the Heart for Investigative Reporting.

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Emily Pisacreta
Producer

Adam Raymonda
Audio wizard

Ellen Weiss
Editor

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‘An Arm and a Leg’: Medicaid Recipients Wrestle To Keep Enrolled

Notice: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a instrument however examine the corresponding audio earlier than quoting the podcast.

Dan: Hey there. what we have now NEVER talked about on this present? Medicaid. The massive, federally-funded medical insurance program for folk with decrease incomes. And I didn’t understand: That’s been an enormous omission. As a result of it seems, Medicaid covers a TON of individuals. Like a couple of quarter of all People. And about forty % of all youngsters. That’s 4 out of each ten youngsters on this nation who’re insured by Medicaid. 

And that is the proper time to have a look at Medicaid as a result of– nicely: tens of tens of millions of individuals are shedding their Medicaid protection proper now. It looks like plenty of these individuals? Nicely, plenty of them may very well nonetheless qualify for Medicaid. 

That is all type of a “Again to the Future” second, which began when COVID hit: The feds primarily hit pause on a factor that used to occur yearly– requiring individuals on Medicaid to re-enroll, to re-establish whether or not they had been eligible. And again then, tons of individuals bought dropped yearly, regardless that plenty of them most likely nonetheless certified. 

The pause lasted by the COVID “public well being emergency,” which resulted in spring 2023. Since then, states have been un-pausing: Doing years and years of re-enrollments– and un-enrollments– . Folks name it the “unwinding.” And it’s been messy. And, one other factor I’ve been studying: Medicaid operates actually in a different way from one state to a different. It even has totally different names. In California, it’s known as Medi-Cal. In Wisconsin, it’s BadgerCare. And this unwinding can look utterly totally different from one state to the subsequent.

We’re gonna look principally at one state– Tennessee, the place this system is named TennCare. And in some methods, in accordance with the numbers on the unwinding, TennCare is… kinda common. 

However the issues some individuals have had, making an attempt to maintain from getting kicked off TennCare? Earlier than this unwinding and through it? They sound fairly unhealthy. We’re gonna hear from a type of individuals– a mother named Ashley Eades. 

Ashley Eades: Yeah. TennCare. Put me by the wringer, I inform you what. 

Dan: We’ll hear how Ashley spent months combating to maintain her son Lucas from getting kicked off TennCare. And we’ll hear from some people who may help us put her story in perspective. Together with people who helped Ashley finally win her combat. Of us who’re combating– in Tennessee and across the nation– to maintain applications like TennCare from placing individuals like Ashley by the wringer. 

That is An Arm and a Leg– a present about why well being care prices so freaking a lot, and what we are able to perhaps do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen round right here is to take one of the enraging, terrifying, miserable components of American life, and to deliver you a present that’s entertaining, empowering, and helpful. Ashley Eades is a single mother in Nashville. She works within the kitchen at Pink’s Sizzling Hen, close to Vanderbilt College. 

Ashley Eades: We’re similar to each different particular person in Nashville making an attempt to say they bought one of the best scorching rooster. 

Dan: Ashley buys her insurance coverage from the Obamacare market, however her son Lucas– he’s 12 — is on TennCare. In April 2023, Ashley bought a discover from TennCare saying, “It’s time to resume your protection!” That means Lucas’s protection. That means, welcome to the unwinding! After I discuss with Ashley, she makes use of one phrase a couple of half-dozen instances: 

Ashley Eades: it simply was a nightmare. It was a nightmare. In order that was the nightmare. A horrible nightmare you may’t get up from. Oh my god, that was a nightmare. 

Dan: So: After Ashley crammed out the renewal packet, she bought one other discover, saying “We want extra info from you.” TennCare wished proof of “unearned earnings”– like financial institution statements, or a letter saying she was entitled to one thing like staff compensation– or a court-ordered fee. However Ashley didn’t have any unearned earnings. Lucas’s dad was alleged to pay baby help, however– as Ashley later wrote to state officers– he didn’t have common employment so couldn’t pay. 

Ashley says she known as TennCare for recommendation and bought instructed, “By no means thoughts. There’s nothing to ship, so that you don’t need to ship us something.” Which turned out to be flawed. A number of weeks later, in Could, TennCare despatched Ashley a letter saying “Why your protection is ending.” 

It gave two causes: First, it mentioned “We despatched you a letter asking for extra information… however you didn’t ship us what we wanted.” It additionally mentioned “We’ve realized that you’ve different insurance coverage” for Lucas. However she didn’t. And never having insurance coverage for Lucas was going to be a direct downside. He bought identified with epilepsy just a few years in the past, and he wanted ongoing therapy. 

Ashley Eades: he was on three totally different medicines. I imply, that alone would price me about $1,500 a month with no medical insurance. And that is anti-seizure remedy. Like we are able to’t simply cease it 

Dan: Yeah. Ashley says she did the whole lot she may consider: mailed in paper kinds, submitted info on-line, and made plenty of cellphone calls.

Ashley Eades: like backwards and forwards on the cellphone with individuals I don’t even know who Italked to, simply dozens and dozens of individuals I talked to. And each single time it was undergo the identical story time and again and over and time and again and simply get transferred Placed on holds, you already know disconnected yelled at, instructed I’m flawed like 

Dan: It went on for months. She reapplied. She was permitted. Then she was un-approved. She appealed. The enchantment was denied. Then, in July, the total nightmare: Lucas ended up within the emergency room after a seizure. Whereas he was formally uninsured. 

Ashley Eades: I simply didn’t know what to do. Like, I used to be shutting down mentally. 

Dan: After which, out of nowhere, a relative talked about {that a} nonprofit known as the Tennessee Justice Heart had helped *her* out with a TennCare utility. Ashley known as the group straight away. 

Ashley Eades: and I’m not a religious particular person, however they had been like a fudging godsend. what I imply? Like, it was wonderful

 Dan: A consumer advocate named Luke Mukundan checked out all of TennCare’s letters to Ashley and confirmed one factor straight away: Ashley wasn’t flawed to be confused. 

Ashley Eades: He’s like going by all of those letters and he’s like, it doesn’t even make sense 

Dan: Later I talked with Luke, on type of a awful Zoom connection. However he mentioned to me: This was complicated, even to him. 

Luke Mukundan: she was offering the data that they requested for, um, 

Dan: However they stored asking the identical questions. And so they stored saying that her son had another insurance coverage. 

Luke Mukundan: after I knew and he or she knew that wasn’t the case

Dan: Luke’s boss on the Tennessee Justice Heart, Diana Gallaher, instructed me she wasn’t shocked that Ashley bought confused by that early query about un-earned earnings. She says the method may be actually complicated. 

Diana Gallaher: Heck, I get confused. I nonetheless, I’ll have a look at a query and say, you already know, wait, what are they asking? How do I reply this one? 

Dan: And also you’ve been doing this for some time, proper? 

Diana Gallaher: Oh, yeah. Yeah. 

Dan: How lengthy have you ever been doing this? 

Diana Gallaher: Since 2003, 2004. 

Dan: Greater than twenty years. After all, Ashley’s been going by this course of at an particularly tough time: The unwinding. When so many individuals had been going by this course of directly. 

For example, Luke and Diana say the assistance traces at TennCare had been super-jammed– like, it wasn’t uncommon to spend 45 minutes or an hour on maintain. 

By the point Ashley discovered the Tennessee Justice Heart, it was August. She’d been combating alone for months. Luke helped Ashley with a brand new enchantment. And on September 22, TennCare despatched Ashley an replace. Her son is permitted. “You qualify for a similar protection you had earlier than,” it says. “And also you’ll haven’t any break in protection.” 

So Ashley’s “nightmare” was one particular person’s expertise of the unwinding. Nevertheless it’s not a one-off: In keeping with experiences from KFF and Georgetown College, greater than two-thirds of the individuals who misplaced Medicaid within the final yr had been disenrolled, like Ashley, for what are known as “procedural causes.” Lacking paperwork.

Now, a few of these individuals who bought dropped for “procedural causes” most likely didn’t even attempt to renew Medicaid as a result of they didn’t want it anymore. They’d new jobs that got here with insurance coverage.

However we all know these people are in a minority. Researchers at KFF– the dad or mum group of our journalist buddies at KFF Well being Information– did a survey of oldsters who bought dropped from Medicaid. Most of them– seventy %– ended up both uninsured or, the largest group, again on Medicaid. And once more, greater than two-thirds of the oldsters who bought dropped had been minimize for “procedural causes”– paperwork. Like Ashley’s son Lucas. 

So, when lots of people can’t renew their Medicaid for “procedural” causes, it appears price that process. And what’s taking place within the unwinding isn’t really a brand new phenomenon. It’s simply un-pausing an outdated process– a system that at all times had these issues. And that’s actually clear in Tennessee, as a result of individuals in Tennessee have been documenting– and combating– these issues for a very long time. 

Subsequent up: Taking TennCare to courtroom. 

This episode of An Arm and a Leg is a co-production of Public Highway Productions and KFF Well being Information. The parents at KFF well being information are wonderful journalists– and in reality, we’re about to listen to from certainly one of them, proper now. 

Brett Kelman: My title is Brett Kelman. 

Dan: Brett’s an enterprise correspondent with KFF Well being Information 

Brett Kelman: And I report from the town of Nashville, the place I’ve lived for about seven years. 

Dan: Brett got here to Nashville initially to cowl well being look after the native every day, the Tennessean. Which meant he heard about Medicaid– about individuals shedding medicaid– loads. 

Brett Kelman: You hear two variations of the identical story. You hear sufferers who get to the physician’s workplace and immediately uncover they don’t have Medicaid after they used to, they usually thought they nonetheless did. And then you definately hear the opposite aspect of that coin. You hear docs, significantly plenty of pediatricians, the place their sufferers get to their workplace after which uncover of their ready rooms they don’t have Medicaid. 

Dan: And by the way in which– you seen how Brett mentioned he heard particularly from pediatricians about this subject in Tennessee. That’s as a result of Tennessee is likely one of the states that by no means expanded Medicaid after the Reasonably priced Care Act took impact. In these states, Medicaid nonetheless covers plenty of youngsters however loads fewer adults than different states. Docs treating sufferers with Medicaid– plenty of them are gonna be pediatricians. 

So, Brett’s listening to all of this seven years in the past– the before-time. Earlier than the unwinding. Earlier than COVID. Folks stored shedding Medicaid and never realizing about it till they bought to the physician’s workplace. And Brett wished to know: how did that occur? He and a colleague ended up doing an enormous investigation. And got here again with a transparent discovering: 

Brett Kelman: More often than not, when individuals lose their Medicaid in Tennessee, it’s not as a result of the state checked out their funds and decided they aren’t certified. Paperwork issues are the first cause that individuals lose Medicaid protection in Tennessee. 

Dan: Brett and his reporting accomplice used a public-records request to get a database with the shape letters despatched to about 300 thousand individuals who wanted to resume their Medicaid protection. 

Brett Kelman: And what we decided was that, you already know, 200,000 plus youngsters, had been despatched a type letter saying that they had been going to lose their Medicaid in Tennessee, once more, not as a result of the state decided they had been ineligible, however as a result of they couldn’t inform. 

Dan: About two thirds of individuals in that database bought kicked off Medicaid for “procedural causes”– paperwork points. That is years earlier than the present “unwinding” however that two-thirds quantity, it’s fairly just like what we’re seeing as we speak.

Brett Kelman: And, you already know, that raises plenty of questions on if we’re doing the system accurately, as a result of do we actually wish to take well being care away from a household who’s low earnings? As a result of anyone tousled a type or a type bought misplaced within the mail. 

Dan: Across the time Brett revealed that story in 2019, the Lester household discovered that that they had misplaced their Medicaid– as a result of a type had gotten misplaced within the mail. It took them three years to get it again. Brett met them on the finish of that journey 

Brett Kelman: they had been a rural Tennessee household, a few rambunctious boys who appeared to injure themselves always. And truthfully, I noticed him virtually get damage whereas I used to be there doing the interview. One of many younger boys had. Climbed as much as the highest of a cat tower. And I consider jumped off as I used to be interviewing his dad and mom and I may see the insurance coverage, I may see the medical claims racking up earlier than my eyes. 

Dan: In 2019, one of many boys had damaged his wrist leaping off the entrance porch. And when the Lesters took him to the physician, that’s after they realized they’d been minimize from Medicaid. Over the subsequent three years, they racked up greater than 100 thousand {dollars} in medical debt– coping with COVID, with extra accidents, with the delivery of one other baby. Lastly, the Tennessee Justice Heart helped them get Medicaid again– and work out what had gone flawed. 

Brett Kelman: And when all of it got here right down to it, we finally decided that this paperwork that their medical insurance hinged on, the medical insurance that they had been entitled to, that they had misplaced it as a result of the state had mailed that paperwork to the flawed place. 

Dan: Oh, and the place had the state been mailing that paperwork to? A horse pasture. 

Brett Kelman: It wasn’t removed from their home, however there was actually nobody receiving mail there 

Dan: Was there like a mailbox for the horses? Like the place did they, the place did it even go? Get left. 

Brett Kelman: I don’t bear in mind if there was a mailbox for the horses. I don’t assume so. I imply, if you consider this chain of occasions, they had been despatched paperwork they had been alleged to fill out and return to maintain their medical insurance, however it went to the horse pasture, so that they didn’t fill it out. Then they had been despatched a letter saying, Hey, you by no means crammed out that paperwork. We’re gonna take your medical insurance away. Nevertheless it went to the horse pasture, so that they didn’t repair it, after which they had been despatched paperwork saying, we’ve minimize off your medical insurance. You received’t have medical insurance as of this date Nevertheless it was despatched to the horse pasture, so that they didn’t find out about it. 

Dan: And their three-year combat to get Medicaid again happened AFTER Brett revealed his preliminary story. So, some issues, it appeared, hadn’t modified a complete lot. However one factor had occurred: In 2020, the Tennessee Justice Heart had filed a class-action lawsuit, demanding that TennCare re-enroll a couple of hundred thousand individuals who had gotten minimize off– the lawsuit alleges, with out due course of. Right here’s Brett’s take: 

Brett Kelman: And sure, I acknowledge that there may simply have a Medicaid recipient who shouldn’t be on high of this and ignores the paperwork and lets it rot in a pile of mail on their kitchen counter. I’ve some mail like that. I’m not going to fake like I’ve by no means executed this, however how do you inform the distinction between that particular person and anyone who by no means bought this paperwork that their baby’s well being care hinges upon? 

Dan: This actual query comes up within the lawsuit. In a submitting, the state’s attorneys say TennCare doesn’t owe a listening to to anyone who says they simply didn’t get paperwork. “The straightforward cause for this coverage is that it’s well-known that mail is ordinarily delivered as addressed, TennCare enrollees have a duty to maintain this system apprised of deal with modifications (as defined to them in TennCare’s notices), and it’s exceedingly widespread for people who’ve missed a deadline to assert they didn’t obtain discover.” 

Class motion lawsuits transfer slowly. This one, filed greater than 4 years in the past, solely went to trial not too long ago. A choose’s resolution is … pending. In a post-trial submitting, the Tennessee Justice Heart tells the tales of 17 individuals minimize off from Medicaid allegedly resulting from errors by TennCare. 

In TennCare’s filings, the state’s attorneys say, in impact: None of this proves there’s a systemic downside. And as a pair individuals have mentioned to me: You don’t need to got down to construct a nasty system. Should you don’t take care to construct one, your system will certainly have issues.

 We despatched TennCare a protracted be aware about what we’ve been studying: About Brett Kelman’s reporting, in regards to the class-action lawsuit, and about what occurred to Ashley Eades. We requested them for any remark– or to tell us in the event that they thought we’d gotten something flawed. We haven’t heard again from them. 

So, let’s zoom out somewhat bit to have a look at how these methods are working throughout 50 states. The particular person to speak to right here is Joan Alker. She’s a professor at Georgetown, and he or she runs the college’s Heart for Kids and Households. 

Joan Alker: Yeah, Medicaid actually is my jam. I’ve been engaged on Medicaid points for about 25 years now, which is somewhat horrifying. 

Dan: So after all she and her colleagues have been monitoring how all 50 states have been coping with the unwinding, compiling all types of knowledge. Once we talked, they’d simply up to date a ticker exhibiting what number of youngsters have been dropped in every state. 

Joan Alker: We simply hit 5 million internet baby Medicaid decline simply as we speak. Um, in order that’s very troubling. 

Dan: And in accordance with Joan Alker’s report, youngsters had been much more prone to be dropped for “procedural causes”– paperwork points– than adults. 

Joan Alker: Most of those youngsters are most likely nonetheless eligible for Medicaid and plenty of of them received’t have one other supply of protection. And that’s what I fear loads about. 

Dan: Nevertheless it varies a TON. A pair states– Maine and Rhode Island– even have MORE youngsters enrolled than when the unwinding began. A half-dozen others have dropped only a few youngsters. 

Joan Alker: However then we had some states that went out actually assertively and aggressively to, um, to To have fewer individuals enrolled in Medicaid 

Dan: Her numbers present that Texas is a standout. They’ve bought one level three million fewer youngsters enrolled in Medicaid than they did earlier than the unwinding… Tennessee– with all the issues documented by Brett Kelman and the Tennessee Justice Heart– is type of across the center of the pack. 

Joan Alker: Sadly, that is the norm. Proper? Once you have a look at the variety of disenrollments nationwide, the common for procedural purple tape causes is 70%. Solely 30 % of these individuals shedding Medicaid nationwide have misplaced it as a result of they’ve clearly been decided to be ineligible. 

Dan: Clearly, Joan Alker shouldn’t be pleased about this. However she can also be not hopeless! The unwinding has been an instance of what occurs– what can occur– if you require individuals to resume their enrollment yearly. However now some states are experimenting with … not requiring that anymore, not less than not for younger youngsters. 

Joan Alker: …as a result of we all know so lots of them are going to stay eligible. They’re low cost to insure. They’re not the place the cash is being spent in our healthcare system. However they want common care. 

Dan: Oregon, Washington, and New Mexico now preserve youngsters enrolled by age six. One other seven states are aiming to do the identical. 

Joan Alker: That is an concept that we’ve been selling for like 15 years and we had been type of crying out within the wilderness for a very long time, however it’s breaking by now 

Dan: I’m not gonna lie. There’s a ton that’s not gonna get fastened with Medicaid anytime quickly. We don’t know but how the choose within the Tennessee Justice Heart’s class-action lawsuit is gonna rule. However seeing these fights, it jogs my memory of one thing I’ve mentioned earlier than on this present: We aren’t gonna win all of them. However we don’t need to lose all of them both.

By the way in which, somewhat information about Ashley Eades– our mother in Nashville, who fought to maintain her son on TennCare. 

Ashley Eades: Final yr, I began going again to highschool, and I’m going to highschool full time, and I’m working full 

Dan: Oh my gosh! 

Dan: And he or she’s home-schooling Lucas. 

Ashley Eades: I used to be like, “we’re going to go to highschool collectively, buddy.” Like, we share a desk, you already know, and he’s like at school and I’m at school. 

Dan: Wow 

Ashley Eades: I needed to get inventive. um, so, yeah, I’m like, working this actually crappy, pungent job and going to highschool 

Dan: And it’s figuring out. 

Ashley Eades: I, um, made Dean’s Checklist this semester, like bought straight A’s. 

Dan: Yeah! 

Dan: Ashley desires to go to Medical faculty. I assumed you’d wish to know. 

Earlier than we go, I simply wish to say THANK YOU. In our final episode, we requested you to assist us perceive sneaky facility charges, by sending your personal medical payments, and you’ve got been coming by in a giant means. We’ve heard from greater than 30 individuals at this level. A few of you’ve got been aggravated by these charges for years– a few you’ve got instructed us about driving 30 or 40 miles throughout city, hoping to keep away from them. And we’ve been listening to from people contained in the medical billing world, providing us some deeper perception. And I couldn’t be pleased-er. Thanks a lot! 

Should you’ve bought a invoice to share, it’s not too late to pitch in, at arm-and-a-leg-show, dot com, slash FEES. I’ll catch you in just a few weeks. Until then, handle your self. 

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta, and edited by Ellen Weiss. Thanks this time to Phil Galewitz of KFF Well being Information, Andy Schneider of Georgetown College’s Heart for Kids and Households, and Gordon Bonnyman of the Tennessee Justice Heart for sharing their experience with us. Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot classes. Gabrielle Healy is our managing editor for viewers. Gabe Bullard is our brand-new engagement editor. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations supervisor. 

And Armand a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an impartial supply of well being coverage analysis, polling and journalism. Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present. 

And because of the Institute for Nonprofit Information for serving as our fiscal sponsor, permitting us to simply accept tax exempt donations. You’ll be able to be taught extra about INN at INN. org. Lastly, due to everyone who helps this present financially– you may take part any time at arm and a leg present dot com, slash, help– thanks for pitching in in case you can, and thanks for listening.

“An Arm and a Leg” is a co-production of KFF Well being Information and Public Highway Productions.

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