Between the cost of treating his kidney disease and his spine surgeries, Shiloh and Denis Velez, both disabled and out of work, can’t afford to lose their Medicaid benefits. So it wasn’t long before they learned that those benefits would end if they didn’t recertify their eligibility with the state before the federal public health emergency ended.
There are nearly 90,800 other Granite Staters who have not done the same and are at risk of suddenly ending up in a doctor’s office or pharmacy without insurance, even though they are still entitled to benefits. This is despite a massive awareness campaign led by the New Hampshire Department of Health and Human Services and dozens of organizations that work with low-income people.
Shiloh Velez, 47, of Merrimack, is also sounding the alarm by sharing NH Healthy Families Facebook alerts.
“I don’t want to see people suffer or go without,” she said. “If it shouldn’t happen, then it shouldn’t happen. Why suffer?
Medicaid enrollments surged across the country as the pandemic and a shortage of child care services forced people out of work, leaving them in need of financial assistance. In New Hampshire, which has 240,517 Medicaid beneficiaries, standard Medicaid enrollment increased 20.1%, while expanded Medicaid saw a 73.5% increase since March 2020.
The federal government has given states additional funds to cover the surge in enrollment — but with a catch.
States were required to keep everyone enrolled — without the standard annual eligibility review process — until the federal public health emergency ended. This is scheduled for October, but the deadline has been extended several times since January 2020 and could be again.
The state’s Medicaid Services Division chose to act before this deadline prompted thousands of desperate pleas for help.
Staff have been meeting weekly since the start of 2020 to remind Medicaid recipients to renew their eligibility before they find out too late that they no longer have coverage. This campaign has included text messages, emails, phone calls, community events, social media and a nationally recognized “pink letter campaign”.
There are approximately 90,800 Granite Staters at risk of losing their Medicaid coverage for one of three reasons: they have aged and are eligible for Medicare, they have not renewed their eligibility, or they are earning too much to be eligible. Those in the latter group can work with one of the Department of Insurance’s “navigators” to explore other options, including public insurance.
“I think a lot of us are in this job because we want to help people,” said state Medicaid director Henry Lipman. “Just letting people lose their coverage because they don’t know what to do didn’t seem like the right thing to do. My take on this is that we want to make sure that when (the federal health emergency) ends, no one who should be covered will lose their benefits.
Lipman’s use of “should be covered” refers to the state’s role as steward of taxpayers’ money. “We have a financial responsibility to make sure the state doesn’t pay for coverage that we shouldn’t be paying for,” he said.
Exit all stops
In May, the National Center on Budget Policy and Priorities held a press briefing, urging states to take a number of steps before the public health emergency expires to minimize the loss of health coverage for their most vulnerable residents.
“This is an opportunity for states to embrace these approaches and improve their systems for both short- and long-term benefit,” said Farah Erzouki, senior policy analyst at the center, at the time. “States now have time to get it right, and it’s time for them to get it right.”
Reached last week, Erzouki paid tribute to the state.
“It’s really great to see that New Hampshire is doing … a lot of things that I think will ensure success at the state level and make sure people are aware of what’s to come,” he said. she declared.
One of its initiatives — the “pink letter campaign” — was blocked by the National Association of Medicaid Directors and the federal Centers for Medicare and Medicaid Services.
The “thumbs up” letter, printed on pink paper for attention, warns recipients of a potential loss of benefits if they do not renew their eligibility before the federal health emergency ends. So far, the state has sent 75,000 letters and by mid-June had renewed eligibility for 23% of recipients. (The actual number of people renewed is higher because some households have more than one person receiving Medicaid.)
It’s one of the many ideas that come out of the department’s weekly meetings.
The division also sent 14,500 emails and text messages between March and June to recipients who had moved and had not updated their addresses. About 1,800 responded.
It has funds to hire up to 33 temporary workers to staff a hotline to reduce wait times. Its social media campaign has included graphic partners who can share on their own channels.
Health and human services staff called every Medicaid recipient who lives in a long-term care facility or who is elderly or disabled. They reached 66% of those people and succeeded in renewing eligibility for 55%. They did the same for households with children, reaching 46% of those beneficiaries and renewing eligibility for 37%.
He has provided organizations such as mental health centers and others that work with low-income people with the names of their clients on Medicaid so they can contact them directly.
The department encourages Medicaid recipients to renew their eligibility online through NH Easy (nheasy.nh.gov), a portal to multiple sources of assistance. This effort led 62% of Medicaid households with an NH Easy account to renew their eligibility, of which 54% are homeless. (Help is also available by calling 1-844-275-3447.)
These efforts enabled 30,000 households to renew their eligibility before the deadline.
“We try to do everything we can to reach people,” Lipman said. Continued extensions of deadlines have allowed the division to try many approaches and come back to those that don’t respond. “We realize that we are not in a sprint. We are in a marathon. This is the advantage of having more time to reach more people.
Outreach also included over 50 community events, often in partnership with other service organizations. In mid-June, Medicaid staff, laptops in hand, joined NH Healthy Families in Portsmouth for their monthly free food distribution. In less than 15 minutes, Medicaid recipients could renew their eligibility and fill a bag of groceries.
Michelle Fraser, an NH Healthy Families volunteer at the Portsmouth event, was thrilled to see the state there.
“There’s a lot of confusion in the community right now,” she said.
Elias Ashooh, executive director of Health Market Connect, agrees. “Navigators” in his organization, some of whom joined Ashooh in Portsmouth, help people who are no longer eligible for Medicaid enroll in federally subsidized public health insurance.
“What surprised me was the real fear among people,” Ashooh said. Some, he said, ignore outreach because they think they have problems with the state. “They don’t understand what’s going on with all this.”
An opportunity to improve
New Hampshire Legal Assistance’s work with low-income people brings it into contact with Medicaid recipients. Attorney Ray Burke said staff were urging those customers to renew their eligibility and be prepared for a surge in calls when people suddenly lose coverage.
Meanwhile, NHLA customer advocacy was aimed at urging the state to facilitate Medicaid eligibility renewals now — and after the pandemic.
They are not alone.
In its January study of Medicaid access in New Hampshire, the Center for Popular Democracy, a progressive advocacy group, found that nearly 60% of respondents said they encountered obstacles when trying to renew. their eligibility, including lack of access to a computer or smartphone, long waits when they called for help, lack of transportation to a state office, missing documents, and uncertainty about the process.
Erzouki of the Center on Budget Policy and Priorities said the changes New Hampshire and other states have been forced to make during the pandemic are an opportunity: “Many states may need to reconsider (their Medicaid renewal) the policy they probably haven’t watched for very long and see where those gaps are and how they can use different strategies to improve.
Burke thinks the pink letter campaign and other outreach activities were good first steps.
The state could continue to make improvements by doing more “ex parte renewals” where it uses existing government data to confirm that a person remains eligible for benefits without subjecting them to an annual review, Burke said. The online portal could be easier to use if the state released security identification numbers more quickly. And while call wait times have improved, there’s still a wait, Burke noted.
As the deadline approaches and pressure mounts to quickly determine Medicaid eligibility for thousands of people, the NHLA is concerned that those eligible for benefits may be mistakenly denied. Burke said they asked the state to consider checking denials for errors.
Part of this will require significant changes to state data systems and possibly additional funding, two hurdles at a very difficult time.
“None of this is easy,” Burke said. “And I think there are legitimate concerns on the part of the state.”
This story was originally posted by New Hampshire Bulletin.