Lost in Medicaid ‘Unwinding’ shuffle: Kentucky cuts health care over clerical error – KFF Health News

The day her Medicaid coverage ended, Beverly Likens was in the hospital after a scary trip to the emergency room.

The Kentucky resident was diagnosed with severe anemia and given a blood transfusion after her hemoglobin levels dropped. Likens, 48 ​​at the time, was days away from having surgery to treat chronic uterine bleeding that she said left her bleeding “constantly.”

But a problem soon emerged: The hospital said it didn’t have Medicaid coverage, putting her procedure in jeopardy. Likens, which is disabled, has been collected by the news. She believed she had done what was necessary to maintain her eligibility. “I was just ready to fall apart,” Likens said, fearing that “I’m going to spend the rest of my life on blood transfusions.”

Millions of people across the country lost Medicaid benefits after a pandemic-era mandate for coverage expired in March — most of them for administrative reasons unrelated to their current eligibility. Even the Biden administration and state officials had prepared for complications in the historic clash of the continuous registration requirement, and had assured the public that they would protect themselves from such lapses.

Likens and an attorney who had been trying to help him keep coverage said technological errors in Kentucky’s eligibility system and state missteps caused Likens to lack coverage, throwing his surgery into limbo. As his situation shows, a lapse of even a few days can have life-changing consequences.

The state should never let Likens go uninsured, said attorney Cara Stewart, director of policy advocacy at Kentucky Voices for Health. Stewart tried to file a new Medicaid application for Likens before her coverage stopped in June. She was stuck in a loop in Kentucky’s online system that “didn’t go away” and prevented the form from going through. “I was just furious,” Stewart said.

Likens should never have had to reapply for coverage, Stewart said, arguing the state violated federal regulations that say before concluding someone is ineligible and terminating benefits, states must consider all scenarios in which anyone could qualify. Likens, who has no children and is not working, must qualify for Medicaid based on her income, which is below federal limits.

Medicaid, a safety net health program run jointly by the federal government and the states, covers millions of people with disabilities, pregnant women, children, adults without children, and the elderly. Often a person who qualifies for Medicaid initially for one reason may still be eligible when life circumstances change, as long as their income remains below certain limits.

Before she lost her coverage, Likens qualified for Medicaid because she had Supplemental Security Income, a program for people with little or no income or assets who are blind, disabled, or at least 65 years old. Likens has several chronic conditions, including diabetes, high blood pressure and heart disease, and said she initially started the program after the death of her grandfather, who was supporting her financially. Likens was his guardian and he did not go to college; after his death, she struggled with depression and anxiety that she still treats with medication and therapy.

In addition to the earnings limits, the SSI program limits the assets of beneficiaries to $2,000 for individuals and $3,000 for couples. After the Social Security Administration told her in March that she was no longer eligible for SSI because she had assets whose cash value exceeded federal limits, a Kentucky agency that oversees Medicaid sent Likens a notice in April that says his health benefits will automatically stop at the end of June.

The state did not assess whether it qualified another way, although regulations from the Centers for Medicare and Medicaid Services require states to consider all factors. Instead, Kentucky said he “may be eligible for Medicaid in another way” and ordered him to reapply.

Kentucky health officials have maintained that they did nothing wrong. In a September letter to the Kentucky Equal Justice Center, a nonprofit organization that provides legal aid, state officials said the requirement to consider whether someone qualifies for Medicaid in a different category does not apply to people with SSI benefits.

Because their eligibility for Medicaid depended solely on their receipt of SSI, “the Department of Medicaid Services does not have sufficient information on the record to determine whether the individual qualifies for another type of Medicaid assistance,” he said. wrote Eric Friedlander, secretary of the Kentucky Cabinet for Health. and Family Services, and Lisa Lee, commissioner of the Department of Medicaid Services. “Individuals receive clear guidance in the notice they receive to submit an application to determine if they are eligible for other types of assistance.”

That explanation is “absolutely wrong,” said Elizabeth Priaulx, a senior disability legal specialist with the National Disability Rights Network. “They failed on many levels.” Priaulx pointed to CMS policy guidance issued in May, which says that if a person with SSI experiences a change in circumstances, states must reassess whether they are eligible for Medicaid in another way before ending coverage.

As of 2021, there were 7.7 million SSI recipients, according to the Social Security Administration.

Spokespeople for the Kentucky Department of Health and Family Services did not respond to multiple requests for comment.

The CMS rule requires states to first try to renew people automatically — a policy designed to help keep eligible people enrolled during what’s known as the Medicaid “drawdown.” States can do so by checking data sources, such as whether a Medicaid recipient is enrolled in other public assistance programs for food and housing, or by checking federal and state income tax information. the income. If that doesn’t work, states must send an enrollee a renewal form to request additional information. Likens said he never had one.

All states do automatic renewals for at least some enrollees. However, states are generally behind such renewals for some beneficiaries, including seniors and people with disabilities, increasing the risk that someone could lose coverage when they shouldn’t, said Joan Alker, executive director of the Georgetown University Center for Children and Families.

“Given the high level of procedural terminations, there are undoubtedly people who are eligible in another category but have fallen through the cracks,” Alker said.

After Likens was told to reapply for Medicaid, technological errors in Kentucky’s online system kept the application in limbo until his benefits ran out in June, Stewart said. The state contracts with Deloitte to operate its eligibility system; a company spokesman declined to comment.

In early July, after spending hours on the phone, Medicaid officials said Likens’ coverage had been reapproved. But it does not show up in the computer systems for Likens providers for days. On July 10, he received an electronic portal message from a nurse at Pikeville Medical Center saying his insurance was listed as inactive, and his surgery might be delayed because of it.

Likens responded that the state said she was “definitely approved for coverage,” and that her updated eligibility status “should be back to active soon.” After constant calls, Stewart said, his Medicaid reinstatement came in mid-July and he operated on July 17.

Likens was reinstated because his income was quite low. Kentucky expanded Medicaid under the Affordable Care Act, which in 2023 means a single adult without children must earn less than $20,120 a year to qualify. But she worries about others who “aren’t as lucky as I am.”

“It’s not fair for any Kentuckian to have to go without health care,” he said.

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