Hoosiers who have been disenrolled have 13 days from the time of postage to respond to an FSSA letter. Factor in several days for shipping, and there isn't much time to prevent a lapse in coverage.
(Devan Ridgway / WFIU-WTIU)
With help from Pathways Day Center in Terre Haute, Don Gilbert and his dog Molly recently moved into an apartment of their own.
Pathways helped enroll him in Medicaid, which enabled Gilbert to have surgeries on his bowels, intestines, and gall bladder.
“I've had it pretty rough. I got scars from here clear to here,” Gilbert chuckled, pointing to his torso.
Don Gilbert recently moved into his first apartment in years. When he lost Medicaid, he was nearly unable to pay rent. (Devan Ridgway)
Gilbert limps as a result of the operations. He’s in physical therapy but needs a leg brace to fully recover.
His problems intensified when a letter arrived at his apartment in July from the Family and Social Services Administration. Gilbert had lost his healthcare.
“My Medicaid, my Medicare, my food stamps, everything was cut,” Gilbert recalled. “I'm thinking, ‘Boy, what am I gonna do now?’”
Since the federal government ended the COVID-19 emergency in April, over 142 thousand Hoosiers have been removed from Medicaid rolls, almost 122 thousand of those for procedural reasons.
Indiana’s Medicaid rolls expanded during the pandemic from 1.4 to over 2.2 million, partly because the FSSA allowed individuals to verify documents themselves. The federal government also prohibited states from disenrolling patients in exchange for funding.
Tracey Hutchings-Goetz, communications and policy director with Hoosier Action, said Indiana’s Medicaid system was working unusually well. But when the emergency declaration was revoked in April, states began redetermining eligibility.
“I can tell you as an organization that talks regularly to thousands of people in this state, I was not hearing problems about Medicaid during the pandemic," Hutchings-Goetz said. “I used to hear them from our members all the time.”
Tracey Hutchings-Goetz and Hoosier Action have followed Medicaid disenrollment since before it went into effect. She said Indiana has never had to handle cases at this volume before. (Ethan Sandweiss)
Eighty-six percent of Hoosiers who lost Medicaid coverage since April did so because of problems with paperwork, compared to the 73 percent national average.
“We're currently on track for a disenrollment of about 600,000 people in this state, 34 percent of those children,” Hutchings-Goetz said. “That comes out to about one in 12 people in Indiana losing their health care coverage over the course of the next year.”
She said procedural disenrollments usually occur when a patient misinterprets the complicated review process or is unable to submit forms on time. As of July, Indiana ranked seventh for the reported rate of procedural disenrollments, on par with North Carolina.
“We had actually done a survey project earlier this year where we found that compared to people surveyed in other states, Hoosiers had a significantly harder time going through redetermination,” Hutchings-Goetz said.
Enrolling for Indiana Medicaid was difficult before, but with the sudden surge of case reviews, technical problems have impaired the FSSA’s ability to send and receive documents on time.
Pathways Day Center in Terre Haute provides housing and healthcare assistance to people experiencing homelessness. (Devan Ridgway)
Gilbert hadn’t received previous letters from the FSSA because they’d been sent to Pathways. The shelter takes mail for homeless clients, and although Gilbert updated his address with the state, the agency still sent redetermination letters to his old address.
Pathways lead case manager Autumn Howell says Gilbert was lucky she checked there right away.
“We get an average week at least 10 FSSA letters of some form,” Howell said. “We don't open the mail, so we don't know how many people have a letter sitting there right now, saying that they've lost their insurance.”
Undelivered mail from the FSSA for homeless clients piles up at Pathways. Under federal law, the center is unable to open letters without permission, and it shreds unread mail after 14 days. (Ethan Sandweiss)
Gilbert was successfully re-enrolled, but Medicaid still won’t cover his leg brace, which he said makes a total recovery impossible.
Disenrollment is personal for Howell. Like Gilbert, the FSSA told her she would lose her benefits, and even though she managed to re-enroll, she wasn't getting the full coverage she used to.
“I call them and I'm telling them, ‘Hey, you know, I just wanted to let somebody know, voice to voice, I've uploaded this paperwork.’ ‘Oh, yeah, we see it, no problem.’ But still to this day, I'm not getting all the medications I'm supposed to be getting,” Howell said.
Autumn Howell (right) helps clients navigate Medicaid disenrollment. But she herself has had trouble getting back on the rolls. (Devan Ridgway)
Howell said paperwork she’d uploaded to the Medicaid portal has disappeared and she was told the FSSA fax machine couldn’t receive her faxes.
“I had a heart attack. I'm a diabetic. I have a son who's autistic,” she said. “If I'm not here to take care of my son my family will step up and I know he'll be provided for, but why not give me the opportunity to be the parent who I’m supposed to be to my son?”
State lawmakers like Indianapolis Democrat Greg Porter want Governor Eric Holcomb to step in and halt redetermination until the procedural disenrollment problem can be diagnosed and dealt with.
“What we ask is the governor say, ‘Okay, let's put a pause right now, not put people off Medicaid, and then see where the deficiencies are and where the gaps are in regard to getting people back up into the system,’” Porter told Indiana Public Media.
State representative Greg Porter is calling for the governor to halt procedural disenrollments. (Ethan Sandweiss)
Howell agrees, “I feel like we could do better on so many levels.”
While disenrollments continue, experts urge those losing Medicaid to get in touch with a Medicaid navigator for assistance with renewal. Most patients who lose coverage have a 90-day window to apply for retroactive coverage.
