Dan Weissmann
Medicaid — the state-federal medical insurance program for low-income and disabled Americans — has minimize greater than 22 million recipients since spring 2023.
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 throughout the covid pandemic.
Many households, together with Ashley’s, nonetheless qualify for Medicaid however misplaced it for “procedural reasons.” Basically, lacking paperwork.
The unwinding course of has been messy.
In 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 have a look at how the unwinding is affecting households.
Then, Dan hears from employees on the Tennessee Justice Center, Joan Alker of Georgetown University’s Center for Children and Families, and KFF Health News correspondent Brett Kelman, who has been masking Medicaid in Tennessee for years.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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‘An Arm and a Leg’: Medicaid Recipients Struggle To Stay Enrolled
Note: “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 test the corresponding audio earlier than quoting the podcast.
Dan: Hey there. You know what we have now NEVER talked about on this present? Medicaid. The huge, federally-funded medical insurance program for people with decrease incomes. And I didn’t notice: That’s been an enormous omission. Because it seems, Medicaid covers a TON of individuals. Like a few quarter of all Americans. And about forty p.c 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 have a look at Medicaid as a result of– properly: tens of thousands and thousands of individuals are dropping their Medicaid protection proper now. It looks as if quite a lot of these folks? Well, quite a lot of them may very well nonetheless qualify for Medicaid.
This is all type of a “Back to the Future” second, which began when COVID hit: The feds primarily 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 bought dropped yearly, regardless that quite a lot of them most likely nonetheless certified.
The pause lasted via the COVID “public health emergency,” which resulted in spring 2023. Since then, states have been un-pausing: Doing years and years of re-enrollments– and un-enrollments– abruptly. People 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 referred to as Medi-Cal. In Wisconsin, it’s BadgerCare. And this unwinding can look fully completely different from one state to the following.
We’re gonna look largely at one state– Tennessee, the place this system is named TennCare. And in some methods, in accordance with the numbers on the unwinding, TennCare is… kinda common.
But the issues some folks have had, attempting to maintain from getting kicked off TennCare? Before 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 will help us put her story in perspective. Including people who helped Ashley in the end win her struggle. Folks who’re combating– in Tennessee and across the nation– to maintain packages like TennCare from placing folks like Ashley via the wringer.
This is An Arm and a Leg– a present about why well being care prices so freaking a lot, and what we will 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 enraging, terrifying, miserable components of American life, and to carry you a present that’s entertaining, empowering, and helpful. Ashley Eades is a single mother in Nashville. She works within the kitchen at Red’s Hot Chicken, close to Vanderbilt University.
Ashley Eades: We’re similar to each different particular person in Nashville attempting to say they bought the most effective scorching hen.
Dan: Ashley buys her insurance coverage from the Obamacare market, however her son Lucas– he’s 12 — is on TennCare. In April 2023, Ashley bought a discover from TennCare saying, “It’s time to renew your coverage!” Meaning Lucas’s protection. Meaning, welcome to the unwinding! When I discuss with Ashley, she makes use of one phrase a few half-dozen instances:
Ashley Eades: it simply was a nightmare. It was a nightmare. So that was the nightmare. A horrible nightmare you’ll be able to’t get up from. Oh my god, that was a nightmare.
Dan: So: After Ashley crammed out the renewal packet, she bought one other discover, saying “We need more information from you.” TennCare needed proof of “unearned income”– like financial institution statements, or a letter saying she was entitled to one thing like employees compensation– or a court-ordered fee. But Ashley didn’t have any unearned earnings. Lucas’s dad was purported to pay baby 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 bought informed, “Never mind. There’s nothing to send, so you don’t have to send us anything.” Which turned out to be incorrect. A number of weeks later, in May, TennCare despatched Ashley a letter saying “Why your coverage is ending.”
It gave two causes: First, it mentioned “We sent you a letter asking for more facts… but you did not send us what we needed.” It additionally mentioned “We’ve learned that you have other insurance” for Lucas. But she didn’t. And not having insurance coverage for Lucas was going to be an instantaneous downside. He bought identified with epilepsy a number of years in the past, and he wanted ongoing therapy.
Ashley Eades: he was on three completely different medicines. I imply, that alone would price me about $1,500 a month with no medical insurance. And that is anti-seizure medicine. Like we will’t simply cease it
Dan: Yeah. Ashley says she did every thing she might consider: mailed in paper varieties, submitted data on-line, and made quite a lot 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 over and over and simply get transferred Put on holds, you recognize disconnected yelled at, informed I’m incorrect like
Dan: It went on for months. She reapplied. She was accepted. Then she was un-approved. She appealed. The enchantment was denied. Then, in July, the complete nightmare: Lucas ended up within the emergency room after a seizure. While he was formally uninsured.
Ashley Eades: I simply didn’t know what to do. Like, I used to be shutting down mentally.
Dan: And then, out of nowhere, a relative talked about {that a} nonprofit referred to as the Tennessee Justice Center had helped *her* out with a TennCare utility. Ashley referred to as the group immediately.
Ashley Eades: and I’m not a non secular particular person, however they have been like a fudging godsend. You know 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 incorrect 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 type of a awful Zoom connection. But he mentioned to me: This was complicated, even to him.
Luke Mukundan: she was offering the knowledge that they requested for, um,
Dan: But they saved asking the identical questions. And they saved saying that her son had another insurance coverage.
Luke Mukundan: once I knew and he or she knew that wasn’t the case
Dan: Luke’s boss on the Tennessee Justice Center, Diana Gallaher, informed me she wasn’t stunned that Ashley bought confused by that early query about un-earned earnings. She says the method may 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 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: More than twenty years. Of course, 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 directly.
For occasion, Luke and Diana say the assistance traces at TennCare have been super-jammed– like, it wasn’t uncommon to spend 45 minutes or an hour on maintain.
By the time Ashley discovered the Tennessee Justice Center, 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 accepted. “You qualify for the same coverage you had before,” it says. “And you’ll have no break in coverage.”
So Ashley’s “nightmare” was one particular person’s expertise of the unwinding. But it’s not a one-off: According to experiences from KFF and Georgetown University, greater than two-thirds of the individuals who misplaced Medicaid within the final yr have been disenrolled, like Ashley, for what are referred to as “procedural reasons.” Missing paperwork.
Now, a few of these individuals who bought dropped for “procedural reasons” most likely didn’t even attempt to renew Medicaid as a result of they didn’t want it anymore. They had new jobs that got here with insurance coverage.
But we all know these people are in a minority. Researchers at KFF– the guardian group of our journalist friends at KFF Health News– did a survey of oldsters who bought dropped from Medicaid. Most of them– seventy p.c– ended up both uninsured or, the largest group, again on Medicaid. And once more, greater than two-thirds of the oldsters who bought dropped have been minimize for “procedural reasons”– 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 occurring within the unwinding isn’t truly a brand new phenomenon. It’s simply un-pausing an previous process– a system that at all times 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.
Next up: Taking TennCare to courtroom.
This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News. The people at KFF well being information are wonderful journalists– and in reality, we’re about to listen to from one among them, proper now.
Brett Kelman: My identify is Brett Kelman.
Dan: Brett’s an enterprise correspondent with KFF Health News
Brett Kelman: And I report from 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 immediately uncover they don’t have Medicaid after they used to, and so they thought they nonetheless did. And then you definitely hear the opposite facet of that coin. You hear medical doctors, notably quite a lot 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 mentioned he heard particularly from pediatricians about this problem in Tennessee. That’s as a result of Tennessee is among the states that by no means expanded Medicaid after the Affordable Care Act took impact. In these states, Medicaid nonetheless covers quite a lot of youngsters however quite a bit fewer adults than different states. Docs treating sufferers with Medicaid– quite a lot of them are gonna be pediatricians.
So, Brett’s listening to all of this seven years in the past– the before-time. Before the unwinding. Before COVID. People saved dropping Medicaid and never figuring out about it till they bought to the physician’s workplace. And Brett needed 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: Most of the time, 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 recognize, 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 bought kicked off Medicaid for “procedural reasons”– paperwork points. This 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 quite a lot of questions on if we’re doing the system accurately, as a result of do we actually wish to take well being care away from a household who’s low earnings? Because someone tousled a kind or a kind bought misplaced within the mail.
Dan: Around the time Brett printed that story in 2019, the Lester household came upon that they’d 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 consistently. And actually, I noticed him virtually get harm whereas I used to be there doing the interview. One of the 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 dad and mom 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 after they discovered they’d been minimize from Medicaid. Over the following three years, they racked up greater than 100 thousand {dollars} in medical debt– coping with COVID, with extra accidents, with the start of one other baby. Finally, the Tennessee Justice Center helped them get Medicaid again– and determine what had gone incorrect.
Brett Kelman: And when all of it got here right down to it, we finally decided that this paperwork that their medical insurance hinged on, the medical insurance that they have been entitled to, they’d misplaced it as a result of the state had mailed that paperwork to the incorrect 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 bear 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 insurance, nevertheless it went to the horse pasture, in order that they didn’t fill it out. Then they have been despatched a letter saying, Hey, you by no means crammed out that paperwork. We’re gonna take your medical insurance away. But it went to the horse pasture, in order that they didn’t repair it, after which they have been despatched paperwork saying, we’ve minimize off your medical insurance. You received’t have medical insurance as of this date But it was despatched to the horse pasture, in order that they didn’t learn about it.
Dan: And their three-year struggle to get Medicaid again occurred AFTER Brett printed his preliminary story. So, some issues, it appeared, hadn’t modified a complete lot. But one factor had occurred: In 2020, the Tennessee Justice Center had filed a class-action lawsuit, demanding that TennCare re-enroll a few hundred thousand individuals who had gotten minimize off– the lawsuit alleges, with out due course of. Here’s Brett’s take:
Brett Kelman: And sure, I acknowledge that there might simply have a Medicaid recipient who is just not on prime 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 executed this, however how do you inform the distinction between that particular person and someone who by no means bought this paperwork that their baby’s well being care hinges upon?
Dan: This actual 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 simply didn’t get paperwork. “The simple reason for this policy is that it is well known that mail is ordinarily delivered as addressed, TennCare enrollees have a responsibility to keep the program apprised of address changes (as explained to them in TennCare’s notices), and it is exceedingly common for individuals who have missed a deadline to claim they did not receive notice.”
Class motion lawsuits transfer slowly. This one, filed greater than 4 years in the past, solely went to trial just lately. A decide’s resolution is … pending. In a post-trial submitting, the Tennessee Justice Center tells the tales of 17 folks minimize off from Medicaid allegedly because of errors by TennCare.
In TennCare’s filings, the state’s attorneys say, in impact: None of this proves there’s a systemic downside. And as a pair folks have mentioned to me: You don’t need to got down to construct a nasty system. If you don’t take care to construct a superb 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 incorrect. We haven’t heard again from them.
So, let’s zoom out somewhat bit to have 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 Center for Children and Families.
Joan Alker: Yeah, Medicaid actually is my jam. I’ve been engaged on Medicaid points for about 25 years now, which is somewhat horrifying.
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. When we talked, they’d simply up to date a ticker displaying what number of youngsters have been dropped in every state.
Joan Alker: We simply hit 5 million internet baby Medicaid decline simply in the present day. Um, in order that’s very troubling.
Dan: And in accordance with Joan Alker’s report, youngsters have been much more more likely to be dropped for “procedural reasons”– paperwork points– than adults.
Joan Alker: Most of those youngsters are most likely nonetheless eligible for Medicaid and lots of of them received’t have one other supply of protection. And that’s what I fear quite a bit about.
Dan: But 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: But 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 bought 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 Center– is type of across the center of the pack.
Joan Alker: Unfortunately, that is the norm. Right? When you have a look at the variety of disenrollments nationwide, the typical for procedural pink tape causes is 70%. Only 30 p.c of these folks dropping Medicaid nationwide have misplaced it as a result of they’ve clearly been decided to be ineligible.
Dan: Obviously, Joan Alker is just not joyful about this. But she can be not hopeless! The unwinding has been an instance of what occurs– what can occur– while you require folks to resume their enrollment yearly. But now some states are experimenting with … not requiring that anymore, not less than 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. But they want common care.
Dan: Oregon, Washington, and New Mexico now hold youngsters enrolled via age six. Another seven states are aiming to do the identical.
Joan Alker: This is an concept that we’ve been selling for like 15 years and we have been type 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 decide within the Tennessee Justice Center’s class-action lawsuit is gonna rule. But seeing these fights, it jogs my memory of one thing I’ve mentioned earlier than on this present: We will not be gonna win all of them. But we don’t need to lose all of them both.
By the best way, somewhat information about Ashley Eades– our mother in Nashville, who fought to maintain her son on TennCare.
Ashley Eades: Last 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 she’s home-schooling Lucas.
Ashley Eades: I used to be like, “we’re going to go to school together, buddy.” Like, we share a desk, you recognize, and he’s like at school and I’m at school.
Dan: Wow
Ashley Eades: I needed to get artistic. um, so, yeah, I’m like, working this actually crappy, smelly job and going to highschool
Dan: And it’s understanding.
Ashley Eades: I, um, made Dean’s List this semester, like bought straight A’s.
Dan: Yeah!
Dan: Ashley needs to go to Medical college. I believed you’d wish to know.
Before 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 via in an enormous manner. We’ve heard from greater than 30 folks at this level. Some of you’ve got been irritated by these charges for years– a few you’ve got 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. Thank you a lot!
If you’ve bought 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 number of weeks. Till then, deal with 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 Health News, Andy Schneider of Georgetown University’s Center for Children and Families, and Gordon Bonnyman of the Tennessee Justice Center 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 Health News. 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 Health News. He’s editorial liaison to this present.
And due to the Institute for Nonprofit News for serving as our fiscal sponsor, permitting us to just accept tax exempt donations. You can be taught extra about INN at INN. org. Finally, due to all people who helps this present financially– you’ll be able to 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 Health News and Public Road Productions.
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