More than 13 million people lost Medicaid coverage this year. Texas is the epicenter of this “terrible” disconnect.

Inyoung Choi, Arlene Aguasvivas and Zinhle Essamua – NBCNews

Erica Olenski, a single mother of three from McKinney, Texas, juggles the responsibilities of motherhood with her full-time job and the demands of work. His 5-year-old child suffered brain cancer.

August was diagnosed in May 2019 and declared cancer-free the following year, but complications persisted. Olenski said he suffered a relapse in September of this year and resumed radiation therapy. About two months later, a letter arrived: The Texas Health Care Commission told him that August and one of his brothers were no longer eligible for Medicaid and would lose coverage unless Olenski provided documentation of his work history.

I had about three weeks before August lost coverage.

“Cancer treatment is quite stressful for a child. Childhood cancer is terrible. “It’s absolutely terrible,” Olenski said. “And then to have something like this, which really seemed like an administrative problem, threaten our sense of stability and security, when we were going through something really traumatic, it was terrible,” he lamented.

Shutdown after the pandemic

In August, in particular, Medicaid provided a lifeline, covering the costs of radiation therapy and the nurses who cared for him 24 hours a day, Olenski said.

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His family is one of many who have experienced the call over the past eight months “disconnection” from Medicaid. States have been widely reviewing participants’ eligibility for the program since April, following a three-year hiatus in eligibility checks during the coronavirus pandemic.

Typically, people enrolled in Medicaid (government health insurance for people with low incomes or disabilities) undergo an annual eligibility review to determine whether they can renew their coverage. But in March 2020, the federal government froze inspections as part of a public health emergency. Thus, people were continuously enrolled in Medicaid and no one was disenrolled for three years.

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That ended when President Joe Biden lifted his pandemic emergency declaration in the spring. Many months later, Medicaid beneficiaries across the country continue to receive letters like Olenski’s as part of a “disconnection” process that will last until May 2024. status quo before the pandemic.

Until December 20, at least 13 million people were excluded from Medicaid in 2023, according to an analysis by KFF, a nonprofit health policy group. Net enrollment in the program (as some people recently enrolled or re-enrolled) fell by approximately 7.8 millionAccording to an analysis by Georgetown University’s Center for Children and Families.

“It’s huge. We have never seen such a decline,” said Joan Alker, executive director of the aforementioned center.

Just over 70% of Medicaid denials in states for which data were available were due to procedural reasons, such as lack of documentation, the KFF analysis found.

Loss of coverage may have life or death consequences.

“For those suffering from a chronic illness or disability, a gap in coverage could result in a significant deterioration of an existing medical condition,” said Jason Fournier, CEO of CommUnityCare Health Centers, a federally qualified health center in Austin, Texas, whose clinics offer free and inexpensive care.

“We know with great confidence that people who lack access to insurance, including Medicaid, will avoid needed health care services due to cost,” he added.

“Epicenter” of disconnection

Texas is zero zone about repealing Medicaid, Alker said. The state is leading the decline in membership, with about 1.7 million members this year, according to KFF. As of late November, nearly 990,000 renewal applications in the state had been denied on procedural grounds.

Daniel Tsai, director of the Center for Medicaid and Children’s Health Insurance Services, said his staff has met with Texas officials to examine the state’s eligibility assessment process and review cases in which people have lost Medicaid.

“We have requested the reinstatement of more than 90,000 people who were wrongly excluded from the program,” Tsai said.

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The Texas Health and Human Services Commission told NBC News in a statement that it has “planned this massive repeal operation for more than a year” and that if problems arise, the commission is “systematically working to resolve any problems and restore coverage to beneficiaries if necessary”.

Tsai said Medicaid enrollment has grown to record levels during the pandemic. So the rollback process now requires “an unprecedented level of effort” as states try to catch up, he added.

“We never had 97 million people in our program,” he said, “and we never tried to do it (the review) all at once.”

Olenski, who works in health care communications, spent what he called a “victorious” few weeks calling social workers and government agencies – anyone who could help – in an attempt to maintain August’s Medicaid coverage. On December 1, he said, he was left for a short time. But that same day, the Texas Health Care Commission reinstated her son’s insurance.

In a statement, the commission said it “did not receive the renewal application in time to again determine eligibility for continued Medicaid coverage” for August.

“The Commission is committed to providing benefits to eligible Texans as quickly as possible,” the statement added. “We have taken several steps, including the use of technology and standardizing on-the-job training, to improve the eligibility process.”

But Marisol Garcia, financial assistant at CommUnityCare Health Centers, said some people have lost their Medicaid benefits without even realizing it.

“We saw a lot of patients who had no idea their Medicaid had ended,” Garcia said. “We were constantly busy all the time.”

Children suffered the most

Cuts have a significant impact on children: Net Medicaid enrollment for children down by more than 3.2 million this year, according to an analysis by Georgetown University. In September, the federal Department of Health announced that half a million children had their coverage restored after the Biden administration worked with states to resolve problems with the renewal process.

Olenski said her fight to keep Augusta on Medicaid took “every ounce of extra time” she had, hours she didn’t think she should have spent.

“My son is a patient with an active brain tumor who is undergoing active treatment. If someone tells me it’s a paperwork problem, I don’t care, so they have to look into it,” he said, “that’s not my job.” “My job is to be your mother and protector, and I deserve to be your mother.”

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