EVERETT — An estimated 38,000 people in Snohomish County “may” start losing Medicaid eligibility in a few months, according to the Washington Health Care Authority.
Statewide that number is 386,000.
“I have had nightmares about it,” said Ann Vining, a staff attorney with Northwest Health Law Advocates, who also lives in Snohomish County.
The estimate of 38,000 people comes from a few sources, such as people who have failed to respond to outreach to fill out renewal forms, and people who did fill out forms, but their income is too high.
Vining has heard this called the biggest event to impact health coverage since the Affordable Care Act was implemented, and she agrees.
“So many people are affected. And so many people are at risk of losing coverage,” she said. “There are people who are going to lose benefits because now they’re not eligible for a program; but many people are going to lose out just because something went wrong in the redetermination or renewal process.”
This all becomes complicated very quickly. But the message from state agencies and others is simple: Update all of your contact information with the Health Care Authority, the Washington Healthplanfinder, your managed care organization and/or the Department of Social and Health Services. They will send mail, emails and even texts to notify you of renewal timelines.
During the federal COVID public health emergency, states waived the renewal requirements and allowed folks to stay covered.
In exchange for this “continuous coverage,” states received increased funding from the federal government for Medicaid.
The increase in Apple Health enrollment during the pandemic drove a record low uninsured rate of 5.3% in 2021, according to the Washington Office of Financial Management.
Under the federal spending bill, signed into law on Dec. 29, 2022, states can restart renewal processes in April, even though the public health emergency remains in effect. Washington state will do so. The extra Medicaid funding will taper off by the end of 2023.
Amy Dobbins, Medicaid eligibility policy section manager for the state Health Care Authority, said that together with the Washington Health Benefit Exchange and Department of Social and Human Services, officials had been planning for a resumption of “normal operations,” even without a firm date. They’ve been working on communications, outreach and plans to keep eligible people enrolled, and to transition ineligible clients off of Medicaid into other coverage.
The HCA has continued to send out notices to clients who failed to renew, extending coverage every three months. For that reason, the HCA estimates the largest number of folks will lose Medicaid coverage in the first three months of the process.
That doesn’t mean clients became ineligible based on higher income, for example. National research has suggested that a meaningful share of Medicaid recipients lose coverage because of “procedural” or “administrative” issues. This comes partly from data on how many clients are disenrolled and then re-enroll within 12 months — known as “churn.”
For example, people might have moved. Nationally, 10% of Medicaid enrollees moved in-state in 2020.
“During the pandemic, you might have moved multiple times. You might have been homeless for a while. Your mail may not be getting to you on a timely and regular basis,” Vining said. “So then you’re not going to take the action that you would need to take to try to stay on benefits or to get moved to something else, if you qualify.”
Enrollees might also face barriers like disabilities or limited English skills that make understanding information and meeting timelines more challenging. And folks who experience such churn report challenges accessing care. They are more likely to be hospitalized for preventable conditions.
The U.S. Department of Health and Human Services estimates out of the 17% of Medicaid enrollees who will lose coverage, nearly half will be from administrative churn. They are, in fact, still eligible.
Another touchpoint for enrollees is their managed care organization, like the Community Health Plan of Washington that administers Apple Health.
Melissa Stevens, vice president for community engagement and growth at the Community Health Plan, said concerns about members with outdated contact information keep her awake at night. Her organization’s outreach is focused on social media, emailing and texting — a plan they started working on over 1½ years ago.
Stevens said she is concerned about people who came onto Apple Health during the pandemic and haven’t had to go through the renewal process.
“People who have been on Medicaid for longer than three years have been through this before. And they understand why they need to do it,” Stevens said. “But a newer person might not understand and might not think that it’s really important.”
Community Health Center of Snohomish County has over 70,000 patients, primarily Medicare and Medicaid clients. They hope to reach patients in person, by mail, on the website and via social media and targeted internet ads, according to Rachael Woods, communications director.
Woods said the clinic translates most printed materials into Spanish, Vietnamese, Russian, Ukrainian and Arabic. At the clinics, patients who need assistance can make an appointment with the Patient Support Services team and request interpreter services in dozens of languages.
Northwest Health Law Advocates will continue to weigh in on changes at the Health Care Authority and DSHS as the process unfolds, Vining said.
A lot of unknowns remain.
Vining worries about people who have aged into Medicare in the past few years but didn’t realize it. Medicare is complicated, with expenses that are difficult for low-income seniors.
“Medicare’s not an affordability program,” she said.
Some improvements just went into effect this month. The Medicare Savings Program removed its “resources” limit when determining eligibility. Depending on income, beneficiaries in the savings program can get what are known as Part B premiums covered — mostly outpatient services. People with poverty-level incomes can also get Part A premiums covered, as well as deductibles, most copayments and coinsurance.
And for those who have lost eligibility for Apple Health because of higher incomes, the state’s Cascade Care Savings plans offer free or low-cost coverage for households earning under 250% of the federal poverty level. That’s income of $33,975 per year for a one-person household.
The Health Care Authority is launching an “Apple Health ambassador program” for community organizations, school districts, health care providers and others to spread the message broadly about the upcoming changes.
“The most important goal,” Dobbins said, “is to ensure a successful transition for people who are no longer eligible for Apple Health to transition into another coverage option.”
Do you have a personal story about Apple Health and the redetermination process? Let us know by phone or email.
Joy Borkholder: 425-339-3430; email@example.com; Twitter: @jlbinvestigates.
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