Monday, Aug 20, 2018
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Ohio’s Medicaid mess

At issue is not a few people failing to follow directions, but a systemic breakdown that the state must fix

More than 60,000 poor Ohioans lost their Medicaid health-care coverage last month because they failed to take required steps to renew their benefits. The system has safeguards to mitigate the damage, such as retroactive coverage and 90-day renewal periods. But the state Department of Medicaid must act now to prevent mass expulsions that could risk the health and well-being of tens of thousands of Ohio residents.

At issue is not a few people failing to follow directions in returning Medicaid renewal forms, but a systemic breakdown in communication, partly precipitated by the state’s ineptness. The Department of Medicaid has made the so-called redetermination, or renewal, process unduly difficult and unreliable. A few simple, common-sense changes would alleviate the problem.

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The state’s 12-page Medicaid renewal forms do not include pre-addressed, postage-paid return envelopes — a safeguard and convenience commonly used by utilities, credit-card companies, and vendors. Many people likely did not get the packets, including homeless-shelter residents and people who moved frequently but did not report a new address.

The state is considering changes in the renewal packets, including pre-addressed envelopes, Samuel Rossi, a spokesman for the Department of Medicaid, told The Blade’s editorial page. But people need to update their addresses, he said, not only to renew coverage but also to receive other important information about their managed care plan. “We don’t want people to have fragmented coverage,” he said.

Anyone who receives Medicaid should expect to renew coverage this year, Mr. Rossi said. Because of Ohio’s Medicaid expansion, many people will renew their benefits for the first time.

The state mailed the renewal packets in December to 170,000 enrollees, but more than one-third did not return forms verifying their incomes. Medicaid administrators don’t know how many of these people are still eligible for Medicaid, but it’s likely that most are.

Given the problem that the state helped create, it should delay cutoffs if the situation persists. The federal-state Medicaid program for poor and disabled residents covers nearly one-fourth of Ohioans.

Federal law requires states to “redetermine” each year whether recipients remain eligible for Medicaid by having them update their household income and other information. The redetermination process was paused in 2014 during the rollout of the Affordable Care Act, Medicaid expansion in Ohio, and the state’s new eligibility system.

The Department of Medicaid resumed monthly notifications for coverage this year. But the large number of unreturned packets suggests that, for many recipients, the renewal process isn’t working.

“The state made this more complicated than it needs to be,” Bill Faith, the executive director of the Coalition on Homelessness and Housing in Ohio, told The Blade’s editorial page.

COHHIO has urged the state to take simple, inexpensive steps to alleviate the problem, such as providing pre-addressed, postage-paid return envelopes. If the envelopes aren’t postage-paid, the state should indicate the required postage, because returning the packets takes more than a standard 49-cent stamp.

In renewing benefits, the state should also communicate better with the faith-based, community, and provider groups that serve Medicaid recipients, and work more closely with local Job and Family Services offices.

Nearly 500,000 more people enrolled in Medicaid after the state expanded eligibility to those with annual incomes of as much as 138 percent of the federal poverty line — about $16,200 for an individual. Medicaid expansion remains Gov. John Kasich’s greatest achievement, but mass expulsions from the program would reverse many of its gains.

The Medicaid Department cites safeguards in the system, including multiple warnings or reminder notices. Once they are terminated, recipients have 90 days to renew, and may receive coverage in the meantime. After 90 days, people on the program can re-apply for benefits.

Safeguards after the fact are prudent. But it’s foolish for the state to endanger some of Ohio’s most vulnerable people, when it can take simple measures to ensure that far fewer of them lose coverage.

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