The day her Medicaid coverage ended, Beverly Likens was hospitalized after a frightened trip to the emergency room.
The Kentucky resident was diagnosed with severe anemia and received a blood transfusion after her hemoglobin levels plummeted. Likens, 48 at the time, was just days after undergoing surgery to treat chronic uterine bleeding, which she said caused her bleeding to be “constant.”
But problems soon arose. Her hospital said she didn’t have Medicaid coverage and her surgery was in jeopardy. Likens, who is disabled, was shaken when he heard the news. She believed she had done what was necessary to maintain her eligibility. She said Likens was “already on the verge of collapsing,” and she feared she would “spend the rest of her life receiving blood transfusions.”
Millions of people across the country lost their Medicaid benefits when the pandemic-era insurance requirement expired in March. Most of them are due to administrative reasons It has nothing to do with actual qualifications. Even the Biden administration and state officials were bracing for complications in the historic loosening of continuous admissions requirements and had promised the public they would prevent such a blunder.
Likens and the attorneys who tried to help her maintain coverage said technical errors in Kentucky’s eligibility system and the state’s missteps caused Likens’ coverage gap and stalled her surgery. As her situation shows, even a delay of a few days can have life-altering consequences for her.
Attorney Carla Stewart, policy advocacy director for Kentucky Voices for Health, said the state should not have left Likens uninsured. Ms. Stewart attempted to submit a new Medicaid application to Likens before coverage was discontinued in June. She was stuck in a loop in Kentucky’s online system that “stuck” and prevented her from submitting the form. “I was just furious,” Stewart said.
Stewart said Likens should never have to reapply for coverage, and the state would have to wait until someone could become eligible before concluding they were ineligible and cutting off benefits. They argued the state violated federal rules that require all scenarios to be considered. Likens, who has no children and does not work, would have been eligible for Medicaid based on her income, which is below federal limits.
Medicaid is a joint federal and state safety-net health care program that serves millions of people with disabilities, pregnant women, children, childless adults, and seniors. In many cases, people who initially qualify for Medicaid for some reason may be able to remain eligible even if their living circumstances change, as long as their income remains below a certain threshold.
Before she lost her insurance, Likens had Supplemental Security Income and was eligible for Medicaid. This is a program for people who are blind, disabled, or at least 65 years old and have little or no income or assets. Likens has multiple chronic illnesses, including diabetes, high blood pressure and heart disease, and she said she first joined the program after her grandfather, who had supported her financially, passed away. Ta. Likens was his caretaker and did not go to university. After his death, she suffered from depression and anxiety, which she still treats with medication and therapy.
In addition to income limits, the SSI program limits beneficiary assets to $2,000 for individuals and $3,000 for married couples. After the Social Security Administration notified her in March that she was ineligible for SSI because she had assets in excess of the federal limit, the Kentucky agency that oversees Medicaid told Likens in April that she sent a notice that their medical benefits would automatically stop at the end of the year. June.
Despite Centers for Medicare and Medicaid Services regulations, the state did not evaluate whether she could qualify otherwise. state required Consider all factors. Instead, the state of Kentucky told her that she “may be otherwise eligible for Medicaid” and told her to reapply.
Kentucky health officials insisted they did nothing wrong.in september letter The requirement that state officials consider Medicaid eligibility in a separate category does not apply to people with SSI benefits, the Kentucky Equal Justice Center, a nonprofit organization that provides legal aid, told the Kentucky Center for Equal Justice. said.
Because her Medicaid eligibility depends solely on receipt of SSI, “the Department of Medicaid Services does not have sufficient record information to determine whether the individual is eligible for another type of Medicaid assistance.” wrote Kentucky Health Cabinet Secretary Eric Friedlander. and Lisa Lee, Secretary of the Department of Family Services and the Department of Medicaid Services. “Individuals will receive clear guidance in the notification they receive to submit their application to determine whether they are eligible for other types of support.”
Elizabeth Priaulx, senior disability law expert at the National Disability Rights Network, said that explanation was “simply wrong”. “They failed on many levels,” Priaulx said. Policy guidance CMS issued in MayIt states that if an SSI patient’s circumstances change, states must reevaluate whether the patient is otherwise eligible for Medicaid before terminating coverage.
As of 2021, 7.7 million SSI recipientsAccording to the Social Security Administration.
A spokeswoman for the Kentucky Cabinet for Health and Family Services did not respond to multiple requests for comment.
CMS regulations require states to first try to automatically renew people. This is a policy designed to help keep eligible people enrolled during a period known as Medicaid “relaxation.” States can be verified by checking data sources such as whether Medicaid recipients are enrolled in other public assistance programs for food and housing, as well as by checking federal and state income tax information. If that doesn’t work, the state must send a letter of notification to the registrant. update form Requesting additional information. Likens said he never got one.
All states have implemented automatic renewal for at least some registrants. But Joanne Alker, executive director of Georgetown University’s Center for Children and Families, said states are generally slow to update some beneficiaries, such as the elderly and people with disabilities, causing enrollees to lose coverage when they shouldn’t. He said there was an increasing risk of losing it.
“Given the high level of the redundancy process, there are definitely people who qualify in other categories, but they are falling through the cracks,” Alker said.
Stewart said Likens was told to reapply for Medicaid, but a technical error in Kentucky’s online system prevented her from applying until her benefits expired in June. The state contracts with Deloitte to operate the eligibility system. A company spokesperson declined to comment.
In early July, after spending hours on the phone, Medicaid officials told her that Likens’ coverage had been reauthorized. But it didn’t show up on Likens’ provider’s computer system for days. On July 10, she received an electronic portal message from a nurse at Pikeville Medical Center informing her that her insurance was listed as invalid and that her surgery could be delayed as a result.
Likens responded that the state had told her “yes, we have approved coverage” and that her updated eligibility status “should be back in effect soon.” After many phone calls, Stewart said, her Medicaid was reinstated in mid-July, and she had surgery on July 17.
Likens’ income was low enough that she returned to work. Kentucky expanded Medicaid under the Affordable Care Act, meaning that by 2023, an adult without children must have an annual income of less than $20,120 to qualify. But she worries about others who “weren’t as lucky as me.”
“It’s not fair that Kentuckians have to go without health care,” she says.
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