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Renewing Medicaid Coverage Could Be Big Challenge

By Rebecca Adams, CQ HealthBeat Associate Editor

September 19, 2014 -- Many people who enrolled in Medicaid this year do not realize that they need to renew their coverage, according to findings from six focus groups presented last week at the Medicaid and CHIP Payment and Access Commission (MedPAC).

The hard work that state and federal officials, providers and nonprofits are putting into finding and enrolling people may be undermined if they do not renew their coverage. Under the health care law (PL 111-148, PL 111-152), people must reapply after a year to maintain coverage, even if their personal circumstances haven't changed.

"It's a sleeper issue," said Mike Perry, a PerryUndem Research/Communication partner, in an interview after he presented the research to the commission, known as MACPAC. "I'm afraid that people will be alarmed when they get this [renewal] notification in the mail without any context."

Many states haven't told people who get Medicaid what to expect in the renewal process. Perry believes that could result in some people losing coverage. Some beneficiaries may not get any information at all before their coverage ends, especially if they have moved since they first enrolled. Perry is urging states that he advises to step up their efforts to make sure people understand when they enroll what they need to do to stay covered.

The research firm interviewed about 60 people in the six groups in late June and July. Enrollees were interviewed in Chicago, where consumers reported some problems; Denver, where people seemed relatively satisfied with their care; and Portland, where one of two groups indicated concerns with specific issues, such as finding a psychiatrist. Each city is in states that expanded Medicaid under the health law.

In other findings, a handful of people said their applications were lost and they had to reapply. But enrollees said the hassle of applying was worth the trouble.

Most people said they didn't get a packet of information after they enrolled to help them understand how to use their coverage. They also had questions about what services are covered in Medicaid, what limits apply to those services, what their own out-of-pocket costs will be, and how to find a physician.

MACPAC Chairwoman Diane Rowland said that the panel has heard anecdotally that navigators are helpful in signing up people who qualify for Medicaid but that many patients feel no one is there to help them figure out how to use services once they've signed up.

Some people who received Medicaid coverage in the past may have outdated information about the program, said Perry.

A lack of information is a big problem. Most of the people who applied hadn't even realized they were eligible. They tried to sign up through, the federal website that handled enrollment for private individual insurance in 36 states, or through other means because they wanted any affordable coverage available. Most said they either had delayed getting care they needed or taken on debt to pay for treatment when they were uninsured.

The number of people in Medicaid and the Children's Health Insurance Program had grown by at least 7.2 million by July when compared to enrollment before Oct. 1, when the new marketplaces under the health care law (PL 111-148, PL 111-152) launched.

Impact of Lost Coverage

The problem of losing coverage can have serious effects, said Ben Sommers, a professor in the Harvard School of Public Health. He spoke at a separate briefing last week sponsored by the Association for Community Affiliated Plans. The group is lobbying for passage of legislation (S 1980, HR 1698) that would ensure 12 months of continuous coverage, regardless of whether income or personal circumstances change during that time.

Some people may lose their benefits without realizing it. If they get costly care when they aren't actually enrolled, they could face high medical bills. Others who do understand that their coverage ended may delay signing up again and put off care that they need so that their conditions worsen. For people with significant chronic conditions and mental health issues, a gap in coverage can be dangerous.

"There are a lot of reasons to worry about this," said Sommers.

One reason is higher overall expenses due to preventable problems and additional administrative costs.

In Ohio, people who lose coverage and then re-enroll are 34 percent more expensive than those continuously enrolled, said Steve Ringel, the president of the Ohio market in the CareSource Health Plan.

"When people lose their Medicaid coverage, it's costly," said Frank Micciche, vice president for public policy and communications at the National Committee for Quality Assurance, a group that ranks the quality of health plans.

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