Medicaid Cancelations

 

Obamacare allowed for expanded Medicaid for all states. For the first few years, the government would cover most of the costs, but after a few years, the state's share would escalate modestly but would still be much less than before the act was in place. At that time, many leaders in Republican states rejected this plan and never expanded eligibility nor access to Medicaid programs in their state, claiming that the plans could suddenly expand and their costs would be too high. For the next several years, and through many court fights, leaders in these states fought against Obamacare in any form. The Supreme Court finally ruled that it was legal but could not require enrollment and canceled the provision called the individual mandate. This made the program more expensive since the healthy young population necessary to balance the insured pool would not be as large. In the reach for almost universal coverage, Medicaid was an important portion, but its hope also was not fully realized. Medicaid and welfare benefits in many Southern states have long been among the most difficult to obtain and among the least expansive in benefits. For example, many states allow mothers to stay on Medicaid for the year after the birth of a child; some states, such as Texas, only allow for two months' coverage after the birth. That barely allows time for the mothers' six-week check-up and there is little time to address any complications found then. Single men of working age are not eligible for coverage in many states.

Here is the way Maryland currently describes its benefits: "Many different groups of people may be eligible for Medicaid in Maryland. As part of health reform, Maryland expanded Medicaid to nearly all adults under age 65 with incomes at or below 138% of the Federal Poverty Level or about $1,564 per month for a household of one person in 2022​.  ​

To be eligible for Medicaid, applicants must meet Medicaid eligibility requirements​. Medicaid requirements are based on state and federal law. Some requirements, such as income limits, vary for different groups of people and household sizes. Children and pregnant women, for example, may be eligible at higher household income limits.”

The Kaiser Family Foundation reported on work requirements and waivers under the pandemic eligibility changes. “The Trump Administration aimed to reshape the Medicaid program by newly approving Section 1115 demonstration waivers that imposed work and reporting requirements as a condition of Medicaid eligibility. However, courts struck down many of these approvals and the Supreme Court recently dismissed pending challenges in these cases. The Court dismissed pending litigation in Arkansas and New Hampshire due to the expiration of Arkansas' waiver as well as the Biden Administration's earlier withdrawals of these approved work requirement waivers. The Biden Administration had concluded that these provisions reduce coverage and thus do not promote the objectives of the Medicaid program. States could have appealed these withdrawal decisions to the HHS Departmental Appeals Board, and Georgia has challenged the withdrawal of its work requirements in court. An initial decision in the Georgia case is currently pending.

Although few Medicaid work and reporting requirements were implemented due to litigation, state withdrawals, and/or pauses during the COVID-19 pandemic, available implementation data from Arkansas suggests that these requirements were confusing to enrollees and result in substantial coverage loss, including among eligible individuals. This recent history of Medicaid work requirements illustrates the tensions between states, changing presidential administrations, and the courts. This issue brief answers key questions about these provisions:”

Right now, in the Republican-dominated House, Representatives are attempting to make Medicaid eligibility tied to work rules. They are again trying to repeal the Affordable Care Act, threatening loss of coverage for millions as explained in this White House press release. Some elected officials are ignoring the reality that many who are on Medicaid are working, but may not have enough hours for insurance coverage at their workplace or cannot afford to buy insurance with the minimum wage jobs they hold. Many others have mental health issues, multiple medical conditions or are elderly and unable to work.

Under the pandemic relief legislation, the government expanded Medicaid since workers lost jobs, became too ill to work, or had family members to care for. Now that the president has declared that the pandemic health emergency is over, many of these provisions are being rolled back. Free school meals for all and other food assistance programs have already been reduced. Programs such as SNAP and Children's Health Care Programs (CHIP) have already seen losses of allocated funds and thus coverage for needy children and seniors. Termination of the emergency allowed states to legally roll back coverage. This rollback is supposed to be gradual and take place over the next year. Several states have already announced their cuts. These states include Arizona, Arkansas, Idaho, New Hampshire, and South Dakota; Republicans govern all but Arizona.

According to the Kaiser Family Foundation, "The Affordable Care Act's (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an individual in 2023) and provided states with an enhanced federal matching rate (FMAP) for their expansion population

To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.”

Those ten states currently are (according to the article above): Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

Catherine Rampell, writing in The Washington Post, reports: Many who will be purged are actually eligible, but administrativesnafus and other issues cause their removals from lists. Since many in this population move frequently looking for affordable housing, and do not update their addresses in the system, they get dropped. Perhaps they cannot afford to take off work for an intake interview or don't have child care or transportation to the local welfare offices. These problems seem simple to those of us used to dealing with bureaucracies, but to a young mother with poor English skills, and other barriers, they seem insurmountable. She further states:

 

"Unfortunately, this red tape is the same reason why lots of eligible families get purged even in a normal, non-end-of-pandemic year. As aberrant as the current “Medicaid unwinding" might appear, it obscures a problem that has long ailed U.S. government programs at virtually all levels: how little federal and state policymakers have done to guarantee access to critical, promised safety-net benefits.

 

Depending on the state, proving and re-proving eligibility for Medicaid (or food stamps, or other programs) can be somewhere between cumbersome and impossible. In some parts of the country, this is deliberate: Government-hating politicians want fewer poor people to get benefits. Rather than changing eligibility requirements (which courts don't always favor), officials set up an obstacle course and hope some people get tripped up.”

 

She also notes that during the pandemic, the expanded coverage for Medicaid included 85-89 million  enrollees. They expect approximately 15 million of those currently enrolled to be cut.

 

We are the richest country in the world. The Affordable Care Act brought millions of Americans into the Healthcare system, Under Medicare, we cover our seniors for 80% of their costs,(that is, unless they   pay also for secondary Insurance, and drug coverage or have Medicaid,) then most of that 20% left is also paid for. During the Pandemic, we showed we could cover more people. We could also improve preventable care and treat patients in routine follow-up care rather than just for emergency or catastrophic care, which is what happens when people have no regular affordable coverage. We have shown that we can do this; it is unconscionable that we are choosing to not do so. We may soon have even fewer options to treat patients. Many areas, especially in rural communities, have lost their local hospitals. Elective surgery and Medicaid payments kept many of these hospitals open. When only emergency surgery was allowed during the pandemic, this financial drain was too much and the hospitals closed, sometimes leaving only a clinic or medical building behind.

 

In another, but related news note this week, NPR reports a judge in Texas (where else?) ruled in favor of Christian religious business groups who did not want to be required to pay for preventative care under the ACA for an HIV prevention drug called PrEP, nor for contraception, addiction counseling or STD screening. The groups claimed that by allowing this preventive care, they would promote services for homosexuality or immoral purposes and be denied their religious freedoms. Unfortunately, this portion of the act also covers breast cancer and other cancer screenings, heart conditions, and other needed services. The judge

wanted to apply his ruling nationwide, but has not yet done so; this is under review/appeal by the Biden administration. Somehow, I think that there may well be many employees working for these businesses who need these medications; I hope they can find different jobs with better bosses.

 

Also in the news this week was the matter of an indictment released by the New York City Grand Jury reviewing illegal payments to a porn star(s) and misuse of accounting tactics to cover up these payments. For the first time in the history of the United States, we have indicted a former president. He will appear for arraignment and to hear the charges on Tuesday. I expect and hope these are the first of many other indictments.

 

‘Til next week-Peace!