In September 2001, following the terrorist attacks on the World Trade Center, New York State launched a temporary health care program called Disaster Relief Medicaid (DRM). During the four-month enrollment period, 342,000 New Yorkers enrolled in DRM to obtain Medicaid benefits. As their eligibility for DRM expired, enrollees could apply for standard Medicaid benefits. However, only 38 percent did so.
Our focus group study sought to discover what happened to those who did not enroll in Medicaid. In a 2002 study for the Kaiser Commission on Medicaid and the Uninsured and the United Hospital Fund, New Yorkers reported mostly positive experiences with DRM.2 Other than citing the long lines, enrollees praised the enrollment process and the quality of services they received. It was a positive aspect of what was otherwise a difficult period in the city's history.
This raises the question: Why did so many enrollees fail to make the transition to standard Medicaid? Some have suggested that these enrollees should not have received DRM benefits but were approved because of the simplified application and approval system. Therefore, when they applied for standard Medicaid, the more detailed process revealed that they were ineligible for benefits and they were thus denied coverage. However, our research indicates that the reasons are much more complex.
Several factors prevented DRM recipients from enrolling in Medicaid. First, many were confused about what to do when their DRM eligibility expired. They did not know if they needed to begin the Medicaid application process anew, or if there was another process for those who had been in DRM. Many enrollees had applied for DRM at hospitals and community centers. Some did not know whether they were supposed to return to those sites or go to a regular Social Services site to apply for standard Medicaid.
There was also confusion about the program for which they should apply. Enrollees did not know if DRM would be extended, a similar program would become permanent, or if their only recourse was to apply for standard Medicaid.
Second, poor communication may have added to the confusion. Most focus group participants did not receive any communications from Medicaid after they enrolled in DRM. In particular, few participants received a letter to inform them that their DRM eligibility was about to end and instruct them how to continue coverage. Many of the Chinese Americans who did receive such a letter could not read it because it was written in English and Spanish only.
Third, many DRM enrollees appear to have determined on their own that they were not eligible for Medicaid or any other public health care program. Enrollees made this decision based on previous experiences with Medicaid or on hearsay from friends and family. Indeed, almost no one in the focus groups had accurate information on income eligibility levels for Medicaid.
Fourth, some DRM enrollees report that they did not want to go through the hassle of applying for Medicaid—enduring long waits in line, providing numerous documents, having eligibility workers ask about their personal affairs, and then waiting up to three months before being informed about eligibility.
Finally, some DRM enrollees applied for Medicaid but were found to be ineligible. This was often due to a change in circumstances, such as an applicant having a higher income or new job.
KEY FOCUS GROUP FINDINGS
Many enrollees do not see improvement in their situation since September 11.
Focus group participants feel their current situation is uncertain and unstable. Many have lost jobs or had their work hours cut. Few are finding work, and there is a lot of competition for jobs that are available. This leaves them feeling hopeless about the future.
Many enrollees appreciated the Disaster Relief Medicaid program.
DRM was a popular program among New Yorkers. Many who enrolled gained a sense of security from having it available to them, whether or not they used it. In addition, many availed themselves of care, using a wide range of medical and dental services. Some had longstanding health issues addressed, others received routine check-ups, and many had prescriptions filled. Some obtained treatment for acute illnesses.
Communication regarding the end of DRM was inconsistent.
Many focus group participants did not receive notification that DRM coverage was ending. Many believed that, prior to the end of their DRM eligibility, they would receive a letter instructing them how to continue coverage. Some learned that their coverage had expired only when they tried to use services. When this happened, many participants left the doctor's office because they could not afford the bill. Moreover, all correspondence from Medicaid is in English or Spanish—languages that many Cantonese speakers can not understand.
Awareness and usage of programs post-DRM seems low.
Many participants were unaware that they could apply for Medicaid while enrolled in DRM. They reported that no one told them about the procedure. Some first learned about this possibility when they received the letter notifying them that DRM was ending. Many did not even try to apply for Medicaid when DRM ended, thinking that they would not be eligible based on their experience or what others told them. Some did not want to go through the hassle of applying. A few younger participants felt they did not need the coverage because they were in good health. Many Chinese-American participants felt they would be denied coverage based on their savings.
The Medicaid application experience continued to be negative.
Many who applied for Medicaid reported long waits, long lines, and inconsiderate staff and said that too many documents and too much personal information were required for application. After losing DRM coverage, many participants rely on their own resourcefulness or the emergency room for their health care needs. Many participants selfmedicate using over-the-counter medications, home remedies, or homeopathic medicines. They say they will do almost anything they can to avoid incurring a doctor bill. Those on medications who cannot afford to pay for them rely on physicians for samples, take lower doses than prescribed, get the prescription filled in a friend's name, or resort to buying medications on the street or the black market. Some do without their medication.
Participants like Family Health Plus but feel it is not designed to help them.
Awareness of Family Health Plus (FHP) is low. Some participants had heard of the program but few had applied for it. Most participants like the benefits offered through the program but feel the income eligibility levels are too low. Some feel that FHP compares poorly with Child Health Plus (CHP). While the benefits in the two programs are similar, the eligibility requirements are not.