Since April, nearly 17,000 Nebraskans have lost their health care coverage previously provided by the state’s Medicaid program.
About half of them lost coverage not because they are ineligible, but for procedural reasons, such as missed paperwork. Over the coming year, that number is expected to grow by tens of thousands more.
The shift in the state’s Medicaid rolls is neither a surprise nor unique to Nebraska. States across the U.S. are adjusting to the end of a federal pandemic-era protection that temporarily barred removal of recipients. The resumption of annual eligibility screening marks what Nebraska Medicaid Director Kevin Bagley called a return to normal.
However, Bagley and Nebraska health care advocates remain concerned that many people are unaware that the process is resuming and that procedural issues, such as the paperwork problems, could cause Nebraskans who still qualify for Medicaid to lose coverage.
“As we watch what’s happening in Nebraska and we watch what’s happening across the country, we’re a little concerned at the early numbers of people who are already losing coverage,” said Amy Behnke, CEO of the Health Center Association of Nebraska, which works statewide on Medicaid outreach and enrollment.
As of early this year, the massive state and federal program provided health care for about one in five Nebraskans. It is intended to provide coverage to low-income individuals and families and people with disabilities. More than half of those on Medicaid are children.
Buoyed by the state’s Medicaid expansion, the number of enrollees grew rapidly in recent years, rising from 249,000 in February 2020 to 392,000 in February 2023. The three-year federal pause, which ended in March, contributed to this growth.
Over the coming year, the state’s Department of Health and Human Services will review the eligibility of each enrollee. Early estimates are that 10%-20% of those who receive Medicaid services in Nebraska, or about 40,000-80,000 people, could be deemed ineligible.
“This is us getting back to what we normally do as a Medicaid program,” said Bagley, noting that the annual reviews have been a feature of Medicaid since 1965.
But for many Medicaid recipients, this will be new.
“We have a lot of people who got benefits during COVID for the very first time and so they’ve never gone through this process,” said Behnke.
Reaching these people has become a key goal of DHHS and advocates. For most, the basic message is the same: Make sure DHHS knows how to find you.
“Our big concern is that there are a lot of people who don’t know that this is coming or they’ve moved and don’t have an address updated so they’re not getting notices about renewals,” said Behnke. “Or they just don’t know what to do with a renewal notice once they get it because they’re not always the easiest to read and follow and figure out what you’re supposed to do next.”
What to do
Officials and health care advocates say Medicaid recipients should make sure their information on file with the Nebraska Department of Health and Human Services is correct. Recipients can update their address by phone, email or through AccessNebraska. For those who have received a renewal notice, Nebraska Appleseed and the Health Center Association of Nebraska have enrollment specialists available to help. Recipients also can contact DHHS directly by calling (855) 632-7633.
Kelsey Arends, a health care access attorney with Nebraska Appleseed, agreed that helping enrollees understand the process will be key to make sure that people don’t lose health coverage for procedural reasons – because they didn’t return paperwork on time, or moved and couldn’t be reached or didn’t understand the paperwork and completed it incorrectly.
When those disenrolled for procedural reasons are added to the up to 80,000 expected to be removed due to changes in income or situation, Arends said the total number removed could reach 145,000 – enough people to fill Memorial Stadium once, then fill it more than halfway full again.
“Those folks who still rely on Medicaid and still qualify but are terminated anyway because of administrative barriers, those are the folks that we are really interested in reaching,” Arends said. “We don’t want to see anyone who still qualifies for Medicaid being terminated for those procedural reasons.”
Behnke said her group, which helps oversee federally qualified health centers across the state, has already heard about hiccups in the renewal process.
Notices come in the wrong language, she said. Or they come partly in English and partly in Spanish.
Some Nebraskans have received two notices on the same day.
“And one says they’re eligible and one says they’re not eligible,” Behnke said.
DHHS said reports of discrepancies have been rare. A spokesman encouraged residents who receive letters with potential errors to contact the department immediately through the AccessNebraska website or by calling 855-632-7633.
From when it resumed reviews in March to the end of June, DHHS has reviewed the eligibility of 77,329 recipients, and has disenrolled 16,974 of them.
According to state statistics, 50% of those disenrolled were removed for procedural reasons, such as recipients who “failed to provide information necessary to complete the Medicaid renewal,” and when DHHS “was unable to contact the client.”
“The hard part is we don’t know why they didn’t respond,” Bagley said. “And that’s been a struggle, I think, for every state.”
He noted that there could be multiple reasons for not returning paperwork. In addition to people who lost it, forgot about it or didn’t understand it, some people likely didn’t fill it out because they knew or believed they weren’t eligible anymore.
“One of the things we want to emphasize,” he said, “is that even if parents are no longer eligible their children may still be.”
So far, Nebraska has disenrolled a smaller percentage of Medicaid enrollees than most states, and removed a smaller percentage for procedural reasons. According to data compiled by health information organization KFF, as of early July 36% of Medicaid recipients reviewed by states had been disenrolled. About 73% of those removed were for procedural reasons. The numbers are not apples to apples, however, because each state has set up its own process for conducting reviews.
With most of Nebraska’s reviews still to happen, advocates are keeping a close eye on the early numbers.
“We’re all affected by how our neighbors are doing,” said Arends. “If folks in our communities don’t have access to coverage and therefore lose access to health care, that impacts the overall health of our communities.”
The state’s hospitals are also paying close attention. In a given year, 60%-80% of total revenue from Nebraska hospitals comes from Medicaid and Medicare.
Jeremy Nordquist, president of the Nebraska Hospital Association, said the group is working with DHHS to explore more proactive ways of getting the word out to Medicaid enrollees.
“Unfortunately, a lot of times, hospitals are having to deal with this in moments of crisis when people come to the emergency room,” Nordquist said.
Bagley said that DHHS has emphasized an outreach approach that targets trusted voices in communities, such as pharmacists, other health care professionals and faith leaders.
While Nordquist acknowledged the department’s efforts, he’s still concerned about the implications.
“If it doesn’t go well, and we don’t get the proactive engagement and outreach right, it will become a significant drain as more and more people fall under charity care,” Nordquist said. “And it just is additional losses for hospitals at a time when half of our hospitals are running in the red right now.”
Hospitals will not turn away people who need emergency care, but he noted the importance of coverage that also covers preventive visits and management of chronic conditions.
“A strong Nebraska requires healthy Nebraskans,” Nordquist said.
Help is available for those who have received notices and are trying to understand how to respond.
But help can be scarce, particularly in rural Nebraska. Behnke shared an example from the health center in Gering near the Wyoming border.
“They had somebody drive almost two hours to come in and receive help from an outreach and enrollment staff person because they didn’t have anybody in their community who could help them with the redetermination process,” she said.
For those who lose Medicaid coverage, DHHS recommends visiting healthcare.gov to get information about and enroll in an Affordable Care Act plan. The Health Center Association has a specialized website – howtogetcare.org – that helps people find new coverage options.
Major insurers who provide ACA plans have already begun courting these potential new customers. Blue Cross and Blue Shield of Nebraska, for instance, has rolled out new marketing for its Heartland BLUE plans. BCBS estimates that about 10% of Nebraskans losing Medicaid eligibility will eventually enroll in an ACA plan. As of the middle of June, nearly 100 former enrollees had signed up with the insurer.
The average cost of an ACA plan is about $700 a month, but for most people, an income-based subsidy can reduce that significantly. According to BCBS, many of those losing Medicaid coverage could end up paying $0-$100 a month for new coverage.
As this process continues, advocates urge current recipients to review their information, respond promptly to any requests from DHHS and plan proactively if it appears that they may lose eligibility.
“We don’t want to scare everyone,” Arends said, “but we want to make sure people are paying attention.”
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