Medicaid — the state-federal medical health insurance program for low-income and disabled People — has lower 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 individuals for years in the course of the covid pandemic.
Many households, together with Ashley’s, nonetheless qualify for Medicaid however misplaced it for “procedural causes.” Mainly, lacking paperwork.
The unwinding course of has been messy.
On this episode, host Dan Weissmann talks with Ashley in regards to the months she spent combating to get her son reenrolled in 2023 to get an on-the-ground have 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 masking 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 % Invisible, and Reveal, from the Middle for Investigative Reporting.
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Emily Pisacreta
Producer
Adam Raymonda
Audio wizard
Ellen Weiss
Editor
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‘An Arm and a Leg’: Medicaid Recipients Wrestle To Keep Enrolled
Be aware: “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 software however verify 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 large, federally-funded medical health insurance program for people with decrease incomes. And I didn’t notice: That’s been an enormous omission. As a result of it seems, Medicaid covers a TON of individuals. Like a few quarter of all People. And about forty % of all kids. That’s 4 out of each ten children 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 hundreds of thousands of individuals are dropping their Medicaid protection proper now. It looks like loads of these individuals? Effectively, loads of them may very well nonetheless qualify for Medicaid.
That is all type of a “Again to the Future” second, which began when COVID hit: The feds primarily hit pause on a factor that used to occur yearly– requiring individuals on Medicaid to re-enroll, to re-establish whether or not they had 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 by means of the COVID “public well being emergency,” which resulted in spring 2023. Since then, states have been un-pausing: Doing years and years of re-enrollments– and un-enrollments– all of sudden. Individuals name it the “unwinding.” And it’s been messy. And, one other factor I’ve been studying: Medicaid operates actually otherwise from one state to a different. It even has totally different names. In California, it’s referred to as Medi-Cal. In Wisconsin, it’s BadgerCare. And this unwinding can look utterly totally different from one state to the subsequent.
We’re gonna look principally at one state– Tennessee, the place this system known as TennCare. And in some methods, in accordance with the numbers on the unwinding, TennCare is… kinda common.
However the issues some individuals have had, attempting to maintain from getting kicked off TennCare? Earlier than this unwinding and through it? They sound fairly unhealthy. We’re gonna hear from a type of individuals– a mother named Ashley Eades.
Ashley Eades: Yeah. TennCare. Put me by means of 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 can assist us put her story in perspective. Together with people who helped Ashley finally win her struggle. Of us who’re combating– in Tennessee and across the nation– to maintain applications like TennCare from placing individuals like Ashley by means of the wringer.
That is An Arm and a Leg– a present about why well being care prices so freaking a lot, and what we will perhaps 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 enraging, terrifying, miserable components 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 Crimson’s Scorching Rooster, close to Vanderbilt College.
Ashley Eades: We’re similar to each different particular person in Nashville attempting to say they obtained one of the best sizzling 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 speak with Ashley, she makes use of one phrase a few half-dozen instances:
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 revenue”– like financial institution statements, or a letter saying she was entitled to one thing like employees compensation– or a court-ordered cost. However Ashley didn’t have any unearned revenue. Lucas’s dad was alleged 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 referred to as TennCare for recommendation and obtained informed, “By no means thoughts. There’s nothing to ship, so that you don’t should ship us something.” Which turned out to be mistaken. Just a few 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 details… 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 an instantaneous drawback. He obtained recognized with epilepsy a couple of years in the past, and he wanted ongoing therapy.
Ashley Eades: he was on three totally different drugs. I imply, that alone would value me about $1,500 a month with no medical health insurance. And that is anti-seizure medicine. Like we will’t simply cease it
Dan: Yeah. Ashley says she did all the things she may consider: mailed in paper kinds, submitted info on-line, and made loads of telephone calls.
Ashley Eades: like forwards and backwards on the telephone with individuals 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 over and over and simply get transferred Placed on holds, you recognize disconnected yelled at, informed I’m mistaken like
Dan: It went on for months. She reapplied. She was authorized. Then she was un-approved. She appealed. The attraction 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 referred to as the Tennessee Justice Middle had helped *her* out with a TennCare software. Ashley referred to as the group straight away.
Ashley Eades: and I’m not a religious particular person, however they had been like a fudging godsend. You recognize what I imply? Like, it was superb
Dan: A consumer advocate named Luke Mukundan checked out all of TennCare’s letters to Ashley and confirmed one factor straight away: Ashley wasn’t mistaken to be confused.
Ashley Eades: He’s like going by means of all of those letters and he’s like, it doesn’t even make sense
Dan: Later I talked with Luke, on type 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. And so they 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, informed me she wasn’t shocked that Ashley obtained confused by that early query about un-earned revenue. She says the method will be actually complicated.
Diana Gallaher: Heck, I get confused. I nonetheless, I’ll have a look at a query and say, you recognize, 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. In fact, Ashley’s been going by means of this course of at an particularly tough time: The unwinding. When so many individuals had been going by means of this course of directly.
As an illustration, Luke and Diana say the assistance strains at TennCare had 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 attraction. And on September 22, TennCare despatched Ashley an replace. Her son is authorized. “You qualify for a similar protection you had earlier than,” it says. “And also you’ll don’t have 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 reviews from KFF and Georgetown College, greater than two-thirds of the individuals who misplaced Medicaid within the final yr had been disenrolled, like Ashley, for what are referred to 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 buddies at KFF Well being Information– did a survey of oldsters who obtained dropped from Medicaid. Most of them– seventy %– ended up both uninsured or, the most important group, again on Medicaid. And once more, greater than two-thirds of the oldsters who obtained dropped had been lower for “procedural causes”– paperwork. Like Ashley’s son Lucas.
So, when lots of people can’t renew their Medicaid for “procedural” causes, it appears price taking a look at that process. And what’s taking place within the unwinding isn’t truly 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 individuals in Tennessee have been documenting– and combating– these issues for a very long time.
Subsequent up: Taking TennCare to courtroom.
This episode of An Arm and a Leg is a co-production of Public Highway Productions and KFF Well being Information. The oldsters at KFF well being information are superb journalists– and in reality, we’re about to listen to from one among them, proper now.
Brett Kelman: My title 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 each day, the Tennessean. Which meant he heard about Medicaid– about individuals dropping medicaid– loads.
Brett Kelman: You hear two variations of the identical story. You hear sufferers who get to the physician’s workplace and instantly uncover they don’t have Medicaid once they used to, and so they thought they nonetheless did. And then you definately hear the opposite facet of that coin. You hear medical doctors, notably 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 way in which– you observed how Brett stated he heard particularly from pediatricians about this challenge in Tennessee. That’s as a result of Tennessee is without doubt one of the states that by no means expanded Medicaid after the Reasonably priced Care Act took impact. In these states, Medicaid nonetheless covers loads of children however loads 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 figuring out 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 individuals 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 purpose that individuals lose Medicaid protection in Tennessee.
Dan: Brett and his reporting associate 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 recognize, 200,000 plus kids, had been despatched a type letter saying that they had been going to lose their Medicaid in Tennessee, once more, not as a result of the state decided they had 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 much like what we’re seeing in the present day.
Brett Kelman: And, you recognize, that raises loads of questions on if we’re doing the system appropriately, as a result of do we actually wish to take well being care away from a household who’s low revenue? As a result of anyone tousled a type or a type obtained misplaced within the mail.
Dan: Across the time Brett printed that story in 2019, the Lester household discovered that that they had misplaced their Medicaid– as a result of a type 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 had been a rural Tennessee household, a few rambunctious boys who appeared to injure themselves always. And actually, I noticed him nearly 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 consider jumped off as I used to be interviewing his mother and father and I may see the insurance coverage, I may 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 lower 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 delivery of one other little one. Lastly, the Tennessee Justice Middle helped them get Medicaid again– and work out 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 had 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 actually 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 had been despatched paperwork they had been alleged to fill out and return to maintain their medical health insurance, however it went to the horse pasture, so that they didn’t fill it out. Then they had 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 had been despatched paperwork saying, we’ve lower off your medical health insurance. You received’t have medical health insurance as of this date Nevertheless it was despatched to the horse pasture, so that they didn’t find out about it.
Dan: And their three-year struggle to get Medicaid again passed off AFTER Brett printed 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 few hundred thousand individuals who had gotten lower off– the lawsuit alleges, with out due course of. Right here’s Brett’s take:
Brett Kelman: And sure, I acknowledge that there may simply have a Medicaid recipient who just isn’t 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 performed this, however how do you inform the distinction between that particular person and anyone 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 attorneys say TennCare doesn’t owe a listening to to anyone who says they only didn’t get paperwork. “The straightforward purpose for this coverage is that it’s well-known that mail is ordinarily delivered as addressed, TennCare enrollees have a duty to maintain this system apprised of handle adjustments (as defined to them in TennCare’s notices), and it’s exceedingly widespread for people who’ve missed a deadline to assert 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 decide’s choice is … pending. In a post-trial submitting, the Tennessee Justice Middle tells the tales of 17 individuals lower off from Medicaid allegedly as a consequence of errors by TennCare.
In TennCare’s filings, the state’s attorneys say, in impact: None of this proves there’s a systemic drawback. And as a pair individuals have stated to me: You don’t should got down to construct a nasty system. In the event you don’t take care to construct a superb one, your system will certainly have issues.
We despatched TennCare an extended observe about what we’ve been studying: About Brett Kelman’s reporting, in regards to 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 just a little bit to take a look at how these methods 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 just a little scary.
Dan: So in fact she and her colleagues have been monitoring how all 50 states have been coping with the unwinding, compiling all types of information. After we talked, they’d simply up to date a ticker displaying what number of children have been dropped in every state.
Joan Alker: We simply hit 5 million internet little one Medicaid decline simply in the present day. Um, in order that’s very troubling.
Dan: And in accordance with Joan Alker’s report, children had been much more prone to be dropped for “procedural causes”– paperwork points– than adults.
Joan Alker: Most of those kids are in all probability nonetheless eligible for Medicaid and lots of of them received’t have one other supply of protection. And that’s what I fear loads about.
Dan: Nevertheless it varies a TON. A pair states– Maine and Rhode Island– even have MORE children enrolled than when the unwinding began. A half-dozen others have dropped only a few children.
Joan Alker: However then we had some states that went out actually assertively and aggressively to, um, to To have fewer individuals enrolled in Medicaid
Dan: Her numbers present that Texas is a standout. They’ve obtained one level three million fewer children 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 type of across the center of the pack.
Joan Alker: Sadly, that is the norm. Proper? Once you have a look at the variety of disenrollments nationwide, the typical for procedural pink tape causes is 70%. Solely 30 % of these individuals dropping Medicaid nationwide have misplaced it as a result of they’ve clearly been decided to be ineligible.
Dan: Clearly, Joan Alker just isn’t completely satisfied about this. However she can also be not hopeless! The unwinding has been an instance of what occurs– what can occur– while you require individuals to resume their enrollment yearly. However now some states are experimenting with … not requiring that anymore, a minimum of not for younger children.
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 children enrolled by means of 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 had been type of crying out within the wilderness for a very long time, however it’s breaking by means of 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 decide 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 should lose all of them both.
By the way in which, just a little 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 recognize, and he’s like in school and I’m in school.
Dan: Wow
Ashley Eades: I needed to get inventive. um, so, yeah, I’m like, working this actually crappy, pungent job and going to highschool
Dan: And it’s figuring out.
Ashley Eades: I, um, made Dean’s Checklist this semester, like obtained straight A’s.
Dan: Yeah!
Dan: Ashley needs to go to Medical faculty. I assumed you’d wish to know.
Earlier than we go, I simply wish 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 by means of in an enormous manner. We’ve heard from greater than 30 individuals at this level. A few of you’ve gotten been irritated by these charges for years– a few you’ve gotten informed 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 a couple of weeks. Until then, care for 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 classes. 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 unbiased 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 because of the Institute for Nonprofit Information for serving as our fiscal sponsor, permitting us to simply accept tax exempt donations. You possibly can be taught 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 Highway Productions.
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