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NC Medicaid drops thousands of people for unreturned paperwork

A stethoscope

Tens of thousands of people are losing Medicaid coverage in North Carolina who might still be eligible.

That’s because, after a pause during the pandemic, state employees are reevaluating millions of people’s eligibility and restarting the process of removing people from the Medicaid rolls. In many cases, what are essentially paperwork issues are costing people their health insurance.

A report by NC Health News found nearly 68,400 people in North Carolina have lost Medicaid since the state resumed terminations in June — and 87% were the result of lots of unreturned paperwork.

Researcher Tricia Brooks of Georgetown University joined WFAE's Nick de la Canal to explain what's going on, and how states could try to minimize the number of people losing their Medicaid coverage.

Nick de la Canal: So, break this down for us, Tricia. How did we arrive at this moment? And why are so many people getting reevaluated now?

Tricia Brooks: Well, the primary reason is that during the COVID public health emergency, states are not allowed to disenroll anyone — they were required to keep them enrolled continuously.

De la Canal: And now the public health emergency has expired so I guess that's why states are now going through and rechecking people's eligibility?

Brooks: That's correct. States are required to now review eligibility for all members over the course of a year.

De la Canal: And let's remind people too, that Medicaid is a federal and state healthcare program for people with low incomes. And so, what's been getting a lot of attention is this high percentage of people losing coverage for procedural reasons. 87% of people who lost coverage in North Carolina in June and July lost it for a procedural reason. What does that mean exactly?

Brooks: So procedural reasons occur when the state lacks information to make an eligibility determination, so they may lack income information or other documentation that would indicate a person is eligible. So, states are required to access data sources available to them, like state wage data or state unemployment compensation. If there's enough information to determine someone eligible, the state is supposed to do that and only send a renewal form requesting information from people who they are not able to confirm eligibility. So, if that paperwork is not received, if the state loses it or if the notice never gets to the individual, those individuals will end up being disenrolled for procedural reasons.

De la Canal: So many of these people might still be eligible, but the state can't reach them, or the paperwork doesn't get returned and so they lose their coverage?

Brooks: That is correct and there was a study done by the Assistant Secretary for Planning and Evaluation at HHS that indicated that as many as 45% of all Medicaid beneficiaries who are disenrolled actually remain eligible.

De la Canal: North Carolina health officials say that they're attempting to reach people through up to two rounds of mail robo calls, texts and emails, and if people are receiving food stamps, they can use some of that information to automate renewals. Do you find all of that to be adequate?

Brooks: What I find to be inadequate is that states can do a better job with their automated renewal systems and the data sources that they use. That, in particular, is the thing that we should be focused on so that we eliminate these paperwork snafus that both states and individuals who are enrolled encounter in trying to renew their coverage.

De la Canal: So, you're saying if the state could find data from other sources, they could use that information rather than relying on people to return paperwork?

Brooks: Yes, and it's not just finding additional data sources. It's making sure that you take a hard look at the programming rules in the system to make sure that it is doing everything possible to identify people who are eligible and renewing their coverage automatically.

De la Canal: Finally, North Carolina is supposed to expand Medicaid this year. That would expand coverage to some 600,000 more people. That can't happen until state lawmakers approve a state budget. But does that mean that some people who lose coverage now could regain coverage later?

Brooks: Yes, that is absolutely correct — and there are a couple of ways that the state could address this.

First of all, if they find that someone has income in the Medicaid expansion range, they could hold those renewals to the end of this year’s cycle in this [expansion] process.

Another option would be for them to actually flag those people and go back when Medicaid expansion is being implemented and send them a note to say ‘We think you're eligible now, please apply.’

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Nick de la Canal is an on air host and reporter covering breaking news, arts and culture, and general assignment stories. His work frequently appears on air and online. Periodically, he tweets: @nickdelacanal