Medicaid — the state-federal medical health insurance program for low-income and disabled People — has reduce greater than 22 million recipients since spring 2023.
Certainly one of them was the son of Ashley Eades. Her household misplaced their Medicaid protection within the “unwinding” of protections that had barred states from dropping folks for years through the covid pandemic.
Many households, together with Ashley’s, nonetheless qualify for Medicaid however misplaced it for “procedural causes.” Principally, lacking paperwork.
The unwinding course of has been messy.
On this episode, host Dan Weissmann talks with Ashley concerning the months she spent combating to get her son reenrolled in 2023 to get an on-the-ground take a look at how the unwinding is affecting households.
Then, Dan hears from workers on the Tennessee Justice Middle, Joan Alker of Georgetown College’s Middle for Youngsters and Households, and KFF Well being Information correspondent Brett Kelman, who has been overlaying Medicaid in Tennessee for years.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 P.c Invisible, and Reveal, from the Middle for Investigative Reporting.
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Emily Pisacreta
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Adam Raymonda
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Ellen Weiss
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‘An Arm and a Leg’: Medicaid Recipients Wrestle To Keep Enrolled
Observe: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a device however test the corresponding audio earlier than quoting the podcast.
Dan: Hey there. You recognize what we’ve got NEVER talked about on this present? Medicaid. The massive, federally-funded medical health insurance program for people with decrease incomes. And I didn’t understand: That’s been an enormous omission. As a result of it seems, Medicaid covers a TON of individuals. Like a couple of quarter of all People. And about forty % of all youngsters. That’s 4 out of each ten youngsters on this nation who’re insured by Medicaid.
And that is the proper time to take a look at Medicaid as a result of– effectively: tens of tens of millions of individuals are dropping their Medicaid protection proper now. It looks as if loads of these folks? Properly, loads of them may very well nonetheless qualify for Medicaid.
That is all sort of a “Again to the Future” second, which began when COVID hit: The feds basically hit pause on a factor that used to occur yearly– requiring folks on Medicaid to re-enroll, to re-establish whether or not they have been eligible. And again then, tons of individuals obtained dropped yearly, despite the fact that loads of them in all probability nonetheless certified.
The pause lasted via the COVID “public well being emergency,” which led to spring 2023. Since then, states have been un-pausing: Doing years and years of re-enrollments– and un-enrollments– suddenly. Individuals name it the “unwinding.” And it’s been messy. And, one other factor I’ve been studying: Medicaid operates actually in a different way from one state to a different. It even has completely different names. In California, it’s known as Medi-Cal. In Wisconsin, it’s BadgerCare. And this unwinding can look fully completely different from one state to the subsequent.
We’re gonna look largely at one state– Tennessee, the place this system known as TennCare. And in some methods, in response to the numbers on the unwinding, TennCare is… kinda common.
However the issues some folks have had, attempting to maintain from getting kicked off TennCare? Earlier than this unwinding and through it? They sound fairly dangerous. We’re gonna hear from a kind of folks– a mother named Ashley Eades.
Ashley Eades: Yeah. TennCare. Put me via the wringer, I inform you what.
Dan: We’ll hear how Ashley spent months combating to maintain her son Lucas from getting kicked off TennCare. And we’ll hear from some people who may help us put her story in perspective. Together with people who helped Ashley finally win her combat. People who’re combating– in Tennessee and across the nation– to maintain packages like TennCare from placing folks like Ashley via the wringer.
That is An Arm and a Leg– a present about why well being care prices so freaking a lot, and what we are able to possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen round right here is to take one of the vital enraging, terrifying, miserable elements of American life, and to deliver you a present that’s entertaining, empowering, and helpful. Ashley Eades is a single mother in Nashville. She works within the kitchen at Pink’s Scorching Hen, close to Vanderbilt College.
Ashley Eades: We’re similar to each different particular person in Nashville attempting to say they obtained the very best scorching rooster.
Dan: Ashley buys her insurance coverage from the Obamacare market, however her son Lucas– he’s 12 — is on TennCare. In April 2023, Ashley obtained a discover from TennCare saying, “It’s time to resume your protection!” That means Lucas’s protection. That means, welcome to the unwinding! After I discuss with Ashley, she makes use of one phrase a couple of half-dozen occasions:
Ashley Eades: it simply was a nightmare. It was a nightmare. In order that was the nightmare. A horrible nightmare you may’t get up from. Oh my god, that was a nightmare.
Dan: So: After Ashley stuffed out the renewal packet, she obtained one other discover, saying “We want extra info from you.” TennCare wished proof of “unearned earnings”– like financial institution statements, or a letter saying she was entitled to one thing like staff compensation– or a court-ordered cost. However Ashley didn’t have any unearned earnings. Lucas’s dad was purported to pay little one assist, however– as Ashley later wrote to state officers– he didn’t have common employment so couldn’t pay.
Ashley says she known as TennCare for recommendation and obtained instructed, “By no means thoughts. There’s nothing to ship, so that you don’t must ship us something.” Which turned out to be mistaken. A couple of weeks later, in Could, TennCare despatched Ashley a letter saying “Why your protection is ending.”
It gave two causes: First, it stated “We despatched you a letter asking for extra info… however you didn’t ship us what we would have liked.” It additionally stated “We’ve realized that you’ve got different insurance coverage” for Lucas. However she didn’t. And never having insurance coverage for Lucas was going to be a direct downside. He obtained identified with epilepsy just a few years in the past, and he wanted ongoing therapy.
Ashley Eades: he was on three completely different drugs. I imply, that alone would price me about $1,500 a month with no medical health insurance. And that is anti-seizure treatment. Like we are able to’t simply cease it
Dan: Yeah. Ashley says she did every part she might consider: mailed in paper types, submitted info on-line, and made loads of cellphone calls.
Ashley Eades: like forwards and backwards on the cellphone with folks I don’t even know who Italked to, simply dozens and dozens of individuals I talked to. And each single time it was undergo the identical story time and again and over and again and again and simply get transferred Placed on holds, you already know disconnected yelled at, instructed I’m mistaken like
Dan: It went on for months. She reapplied. She was accredited. Then she was un-approved. She appealed. The enchantment was denied. Then, in July, the total nightmare: Lucas ended up within the emergency room after a seizure. Whereas he was formally uninsured.
Ashley Eades: I simply didn’t know what to do. Like, I used to be shutting down mentally.
Dan: After which, out of nowhere, a relative talked about {that a} nonprofit known as the Tennessee Justice Middle had helped *her* out with a TennCare software. Ashley known as the group immediately.
Ashley Eades: and I’m not a non secular particular person, however they have been like a fudging godsend. You recognize what I imply? Like, it was wonderful
Dan: A consumer advocate named Luke Mukundan checked out all of TennCare’s letters to Ashley and confirmed one factor immediately: Ashley wasn’t mistaken to be confused.
Ashley Eades: He’s like going via all of those letters and he’s like, it doesn’t even make sense
Dan: Later I talked with Luke, on sort of a awful Zoom connection. However he stated to me: This was complicated, even to him.
Luke Mukundan: she was offering the data that they requested for, um,
Dan: However they saved asking the identical questions. They usually saved saying that her son had another insurance coverage.
Luke Mukundan: after I knew and he or she knew that wasn’t the case
Dan: Luke’s boss on the Tennessee Justice Middle, Diana Gallaher, instructed me she wasn’t stunned that Ashley obtained confused by that early query about un-earned earnings. She says the method will be actually complicated.
Diana Gallaher: Heck, I get confused. I nonetheless, I’ll take a look at a query and say, you already know, wait, what are they asking? How do I reply this one?
Dan: And also you’ve been doing this for some time, proper?
Diana Gallaher: Oh, yeah. Yeah.
Dan: How lengthy have you ever been doing this?
Diana Gallaher: Since 2003, 2004.
Dan: Greater than twenty years. After all, Ashley’s been going via this course of at an particularly tough time: The unwinding. When so many individuals have been going via this course of without delay.
As an example, Luke and Diana say the assistance strains at TennCare have been super-jammed– like, it wasn’t uncommon to spend 45 minutes or an hour on maintain.
By the point Ashley discovered the Tennessee Justice Middle, it was August. She’d been combating alone for months. Luke helped Ashley with a brand new enchantment. And on September 22, TennCare despatched Ashley an replace. Her son is accredited. “You qualify for a similar protection you had earlier than,” it says. “And also you’ll haven’t any break in protection.”
So Ashley’s “nightmare” was one particular person’s expertise of the unwinding. Nevertheless it’s not a one-off: In accordance with experiences from KFF and Georgetown College, greater than two-thirds of the individuals who misplaced Medicaid within the final yr have been disenrolled, like Ashley, for what are known as “procedural causes.” Lacking paperwork.
Now, a few of these individuals who obtained dropped for “procedural causes” in all probability didn’t even attempt to renew Medicaid as a result of they didn’t want it anymore. That they had new jobs that got here with insurance coverage.
However we all know these people are in a minority. Researchers at KFF– the dad or mum group of our journalist friends at KFF Well being Information– did a survey of parents who obtained dropped from Medicaid. Most of them– seventy %– ended up both uninsured or, the largest group, again on Medicaid. And once more, greater than two-thirds of the parents who obtained dropped have been reduce for “procedural causes”– paperwork. Like Ashley’s son Lucas.
So, when lots of people can’t renew their Medicaid for “procedural” causes, it appears value that process. And what’s taking place within the unwinding isn’t really a brand new phenomenon. It’s simply un-pausing an outdated process– a system that all the time had these issues. And that’s actually clear in Tennessee, as a result of folks in Tennessee have been documenting– and combating– these issues for a very long time.
Subsequent up: Taking TennCare to court docket.
This episode of An Arm and a Leg is a co-production of Public Street Productions and KFF Well being Information. The oldsters at KFF well being information are wonderful journalists– and actually, we’re about to listen to from one in all them, proper now.
Brett Kelman: My identify is Brett Kelman.
Dan: Brett’s an enterprise correspondent with KFF Well being Information
Brett Kelman: And I report from the town of Nashville, the place I’ve lived for about seven years.
Dan: Brett got here to Nashville initially to cowl well being look after the native day by day, the Tennessean. Which meant he heard about Medicaid– about folks dropping medicaid– quite a bit.
Brett Kelman: You hear two variations of the identical story. You hear sufferers who get to the physician’s workplace and abruptly uncover they don’t have Medicaid once they used to, and so they thought they nonetheless did. And then you definitely hear the opposite facet of that coin. You hear docs, significantly loads of pediatricians, the place their sufferers get to their workplace after which uncover of their ready rooms they don’t have Medicaid.
Dan: And by the best way– you seen how Brett stated he heard particularly from pediatricians about this situation in Tennessee. That’s as a result of Tennessee is among the states that by no means expanded Medicaid after the Inexpensive Care Act took impact. In these states, Medicaid nonetheless covers loads of youngsters however quite a bit fewer adults than different states. Docs treating sufferers with Medicaid– loads of them are gonna be pediatricians.
So, Brett’s listening to all of this seven years in the past– the before-time. Earlier than the unwinding. Earlier than COVID. Individuals saved dropping Medicaid and never realizing about it till they obtained to the physician’s workplace. And Brett wished to know: how did that occur? He and a colleague ended up doing an enormous investigation. And got here again with a transparent discovering:
Brett Kelman: More often than not, when folks lose their Medicaid in Tennessee, it’s not as a result of the state checked out their funds and decided they aren’t certified. Paperwork issues are the first cause that folks lose Medicaid protection in Tennessee.
Dan: Brett and his reporting companion used a public-records request to get a database with the shape letters despatched to about 300 thousand individuals who wanted to resume their Medicaid protection.
Brett Kelman: And what we decided was that, you already know, 200,000 plus youngsters, had been despatched a kind letter saying that they have been going to lose their Medicaid in Tennessee, once more, not as a result of the state decided they have been ineligible, however as a result of they couldn’t inform.
Dan: About two thirds of individuals in that database obtained kicked off Medicaid for “procedural causes”– paperwork points. That is years earlier than the present “unwinding” however that two-thirds quantity, it’s fairly just like what we’re seeing right now.
Brett Kelman: And, you already know, that raises loads of questions on if we’re doing the system appropriately, as a result of do we actually need to take well being care away from a household who’s low earnings? As a result of someone tousled a kind or a kind obtained misplaced within the mail.
Dan: Across the time Brett revealed that story in 2019, the Lester household came upon that that they had misplaced their Medicaid– as a result of a kind had gotten misplaced within the mail. It took them three years to get it again. Brett met them on the finish of that journey
Brett Kelman: they have been a rural Tennessee household, a few rambunctious boys who appeared to injure themselves continually. And actually, I noticed him virtually get harm whereas I used to be there doing the interview. One of many younger boys had. Climbed as much as the highest of a cat tower. And I imagine jumped off as I used to be interviewing his mother and father and I might see the insurance coverage, I might see the medical claims racking up earlier than my eyes.
Dan: In 2019, one of many boys had damaged his wrist leaping off the entrance porch. And when the Lesters took him to the physician, that’s once they realized they’d been reduce from Medicaid. Over the subsequent three years, they racked up greater than 100 thousand {dollars} in medical debt– coping with COVID, with extra accidents, with the beginning of one other little one. Lastly, the Tennessee Justice Middle helped them get Medicaid again– and determine what had gone mistaken.
Brett Kelman: And when all of it got here right down to it, we ultimately decided that this paperwork that their medical health insurance hinged on, the medical health insurance that they have been entitled to, that they had misplaced it as a result of the state had mailed that paperwork to the mistaken place.
Dan: Oh, and the place had the state been mailing that paperwork to? A horse pasture.
Brett Kelman: It wasn’t removed from their home, however there was definitely nobody receiving mail there
Dan: Was there like a mailbox for the horses? Like the place did they, the place did it even go? Get left.
Brett Kelman: I don’t keep in mind if there was a mailbox for the horses. I don’t suppose so. I imply, if you consider this chain of occasions, they have been despatched paperwork they have been purported to fill out and return to maintain their medical health insurance, nevertheless it went to the horse pasture, so that they didn’t fill it out. Then they have been despatched a letter saying, Hey, you by no means stuffed out that paperwork. We’re gonna take your medical health insurance away. Nevertheless it went to the horse pasture, so that they didn’t repair it, after which they have been despatched paperwork saying, we’ve reduce off your medical health insurance. You gained’t have medical health insurance as of this date Nevertheless it was despatched to the horse pasture, so that they didn’t learn about it.
Dan: And their three-year combat to get Medicaid again passed off AFTER Brett revealed his preliminary story. So, some issues, it appeared, hadn’t modified an entire lot. However one factor had occurred: In 2020, the Tennessee Justice Middle had filed a class-action lawsuit, demanding that TennCare re-enroll a couple of hundred thousand individuals who had gotten reduce off– the lawsuit alleges, with out due course of. Right here’s Brett’s take:
Brett Kelman: And sure, I acknowledge that there might simply have a Medicaid recipient who shouldn’t be on high of this and ignores the paperwork and lets it rot in a pile of mail on their kitchen counter. I’ve some mail like that. I’m not going to faux like I’ve by no means achieved this, however how do you inform the distinction between that particular person and someone who by no means obtained this paperwork that their little one’s well being care hinges upon?
Dan: This precise query comes up within the lawsuit. In a submitting, the state’s legal professionals say TennCare doesn’t owe a listening to to anyone who says they only didn’t get paperwork. “The straightforward cause for this coverage is that it’s well-known that mail is ordinarily delivered as addressed, TennCare enrollees have a accountability to maintain this system apprised of handle adjustments (as defined to them in TennCare’s notices), and it’s exceedingly frequent for people who’ve missed a deadline to say they didn’t obtain discover.”
Class motion lawsuits transfer slowly. This one, filed greater than 4 years in the past, solely went to trial just lately. A choose’s determination is … pending. In a post-trial submitting, the Tennessee Justice Middle tells the tales of 17 folks reduce off from Medicaid allegedly because of errors by TennCare.
In TennCare’s filings, the state’s legal professionals say, in impact: None of this proves there’s a systemic downside. And as a pair folks have stated to me: You don’t must got down to construct a nasty system. In the event you don’t take care to construct an excellent one, your system will certainly have issues.
We despatched TennCare a protracted word about what we’ve been studying: About Brett Kelman’s reporting, concerning the class-action lawsuit, and about what occurred to Ashley Eades. We requested them for any remark– or to tell us in the event that they thought we’d gotten something mistaken. We haven’t heard again from them.
So, let’s zoom out a bit of bit to take a look at how these programs are working throughout 50 states. The particular person to speak to right here is Joan Alker. She’s a professor at Georgetown, and he or she runs the college’s Middle for Youngsters and Households.
Joan Alker: Yeah, Medicaid actually is my jam. I’ve been engaged on Medicaid points for about 25 years now, which is a bit of horrifying.
Dan: So after all she and her colleagues have been monitoring how all 50 states have been coping with the unwinding, compiling every kind of knowledge. Once we talked, they’d simply up to date a ticker exhibiting what number of youngsters have been dropped in every state.
Joan Alker: We simply hit 5 million web little one Medicaid decline simply right now. Um, in order that’s very troubling.
Dan: And in response to Joan Alker’s report, youngsters have been much more more likely to be dropped for “procedural causes”– paperwork points– than adults.
Joan Alker: Most of those youngsters are in all probability nonetheless eligible for Medicaid and lots of of them gained’t have one other supply of protection. And that’s what I fear quite a bit about.
Dan: Nevertheless it varies a TON. A pair states– Maine and Rhode Island– even have MORE youngsters enrolled than when the unwinding began. A half-dozen others have dropped only a few youngsters.
Joan Alker: However then we had some states that went out actually assertively and aggressively to, um, to To have fewer folks enrolled in Medicaid
Dan: Her numbers present that Texas is a standout. They’ve obtained one level three million fewer youngsters enrolled in Medicaid than they did earlier than the unwinding… Tennessee– with all the issues documented by Brett Kelman and the Tennessee Justice Middle– is sort of across the center of the pack.
Joan Alker: Sadly, that is the norm. Proper? Whenever you take a look at the variety of disenrollments nationwide, the common for procedural crimson tape causes is 70%. Solely 30 % of these folks dropping Medicaid nationwide have misplaced it as a result of they’ve clearly been decided to be ineligible.
Dan: Clearly, Joan Alker shouldn’t be glad about this. However she can be not hopeless! The unwinding has been an instance of what occurs– what can occur– if you require folks to resume their enrollment yearly. However now some states are experimenting with … not requiring that anymore, at the very least not for younger youngsters.
Joan Alker: …as a result of we all know so lots of them are going to stay eligible. They’re low cost to insure. They’re not the place the cash is being spent in our healthcare system. However they want common care.
Dan: Oregon, Washington, and New Mexico now maintain youngsters enrolled via age six. One other seven states are aiming to do the identical.
Joan Alker: That is an concept that we’ve been selling for like 15 years and we have been sort of crying out within the wilderness for a very long time, nevertheless it’s breaking via now
Dan: I’m not gonna lie. There’s a ton that’s not gonna get mounted with Medicaid anytime quickly. We don’t know but how the choose within the Tennessee Justice Middle’s class-action lawsuit is gonna rule. However seeing these fights, it jogs my memory of one thing I’ve stated earlier than on this present: We aren’t gonna win all of them. However we don’t must lose all of them both.
By the best way, a bit of information about Ashley Eades– our mother in Nashville, who fought to maintain her son on TennCare.
Ashley Eades: Final yr, I began going again to highschool, and I’m going to highschool full time, and I’m working full
Dan: Oh my gosh!
Dan: And he or she’s home-schooling Lucas.
Ashley Eades: I used to be like, “we’re going to go to highschool collectively, buddy.” Like, we share a desk, you already know, and he’s like in school and I’m in school.
Dan: Wow
Ashley Eades: I needed to get artistic. um, so, yeah, I’m like, working this actually crappy, pungent job and going to highschool
Dan: And it’s understanding.
Ashley Eades: I, um, made Dean’s Listing this semester, like obtained straight A’s.
Dan: Yeah!
Dan: Ashley needs to go to Medical faculty. I believed you’d need to know.
Earlier than we go, I simply need to say THANK YOU. In our final episode, we requested you to assist us perceive sneaky facility charges, by sending your personal medical payments, and you’ve got been coming via in an enormous means. We’ve heard from greater than 30 folks at this level. A few of you may have been irritated by these charges for years– a few you may have instructed us about driving 30 or 40 miles throughout city, hoping to keep away from them. And we’ve been listening to from people contained in the medical billing world, providing us some deeper perception. And I couldn’t be pleased-er. Thanks a lot!
In the event you’ve obtained a invoice to share, it’s not too late to pitch in, at arm-and-a-leg-show, dot com, slash FEES. I’ll catch you in just a few weeks. Until then, maintain your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta, and edited by Ellen Weiss. Thanks this time to Phil Galewitz of KFF Well being Information, Andy Schneider of Georgetown College’s Middle for Youngsters and Households, and Gordon Bonnyman of the Tennessee Justice Middle for sharing their experience with us. Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot periods. Gabrielle Healy is our managing editor for viewers. Gabe Bullard is our brand-new engagement editor. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations supervisor.
And Armand a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an impartial supply of well being coverage analysis, polling and journalism. Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present.
And due to the Institute for Nonprofit Information for serving as our fiscal sponsor, permitting us to just accept tax exempt donations. You’ll be able to study extra about INN at INN. org. Lastly, due to all people who helps this present financially– you may take part any time at arm and a leg present dot com, slash, assist– thanks for pitching in when you can, and thanks for listening.
“An Arm and a Leg” is a co-production of KFF Well being Information and Public Street Productions.
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