Erika Olensky, a single mother of three in McKinney, Texas, is juggling her responsibilities as a parent and a full-time job on top of the burden of her 5-year-old son's brain tumor.
August was diagnosed with cancer in May 2019 and was declared cancer-free the following year, but medical complications lingered. He then had a relapse in September of this year and restarted radiation therapy, Olensky said. About two months later, a letter arrived. The Texas Health and Human Services Commission said August and one of his siblings are no longer eligible for Medicaid and will have it terminated unless Olensky can provide documentation of his work history.
She had about three weeks before August lost insurance coverage.
“It's already stressful enough to have a child and go through cancer treatment. I mean, childhood cancer is bad. It's just bad,” Dr. Orensky said. “And it was terrible for something like this to happen that really seemed like an administrative issue and threaten our sense of stability and safety as we were going through a really traumatic event. ”
Especially for August, Medicaid was a lifeline. Insurance covered radiation therapy and a private nurse to care for him 24 hours a day, Orensky said.
Her family is one of many who have had to navigate a phenomenon known as Medicaid “rollback” over the past eight months. Since April, states have been conducting a major reassessment of her eligibility for the three-year Medicaid program. Eligibility checks will be suspended during the coronavirus pandemic.
Typically, people with Medicaid (the government-provided health insurance for people with low incomes or disabilities) undergo an annual eligibility test to determine whether they can renew their coverage. But in March 2020, the federal government froze the checks as part of the public health emergency. So people were continuously enrolled in Medicaid and no one dropped out for three years.
That stopped when President Joe Biden lifted the state of emergency in the spring. Months later, Medicaid enrollees across the country are still receiving letters like Olensky's as part of the “rewind” process. This process is expected to continue until May. After that, we will return to the pre-pandemic status quo.
At least as of December 20th, 13 million people They would have been disenrolled from Medicaid in 2023, according to an analysis by KFF, a nonprofit organization focused on health policy. Net enrollment in the program (taking into account some new enrollments or reenrollments) fell by about 7.8 million people, according to the association's analysis. Georgetown University Center for Children and Families.
“This is huge. We've never seen a decline like this,” said Joan Alker, the center's executive director.
According to KFF's analysis, more than 70% of Medicaid disenrollments in states with available data were due to procedural reasons such as insufficient documentation.
Even if you eventually recover, losing coverage can be a matter of life or death.
Jason Fournier, CEO of Community Care Health Center, a federally qualified health center with clinics in Austin, Texas, said, “For people with chronic illnesses and disabilities, losing insurance is a big deal. can actually significantly worsen pre-existing medical conditions.” We provide free and low-cost care. “We clearly know that individuals without access to insurance, including Medicaid, will forego services they actually need because of cost.”
Alker said Texas is “ground zero” for Medicaid relief. The state has the highest number of defectors in the U.S., with about 1.7 million this year, according to KFF. As of the end of November, there were approximately 990,000 renewal applications in the state. had been rejected For procedural reasons.
Daniel Tsai, director of the Centers for Medicaid and Children's Health Insurance Program Services, said his staff met with Texas officials to review the state's eligibility evaluation process and evaluate cases where people lost Medicaid.
“We have called on the state of Texas to reinstate more than 90,000 people who were wrongfully disenrolled from the program,” Tsai said.
The Texas Health and Human Services Commission said in a statement to NBC News that “this massive mitigation effort has been planned for more than a year,” adding that if problems arise, the commission will “resolve them and… “We are working systematically to restore coverage to beneficiaries where necessary.” . ”
Tsai said Medicaid enrollment has increased to an all-time high during the pandemic. So now, as states try to catch back, the rollback process requires an “unprecedented level of effort,” he said.
“Never before have we had 97 million people enrolled in this program,” Tsai said. “And we've never tried to do this all at once.”
Olensky, who works in medical communications, said she has had a number of “setbacks” that keep her calling caseworkers and state agencies — anyone who can help — to maintain her Medicaid coverage in August. Spent a week. He was temporarily laid off Dec. 1, she said. However, the Texas Health and Human Services Commission reinstated August coverage on the same day.
The commission said in a statement that it was “not in time to re-determine eligibility for continued Medicaid coverage” in August.
“HHSC will take all possible steps to provide benefits to eligible Texans as quickly as possible,” the statement added. “We have taken several steps to improve the eligibility process, including leveraging technology and standardizing on-the-job training.”
But Marisol Garcia, a financial assistant at Community Care Health Center, said some people are losing their Medicaid benefits without realizing it.
“We see a lot of patients who don't know their Medicaid has ended,” Dr. Garcia said. “We're always busy.”
Children have been disproportionately affected by the mitigation, with net Medicaid enrollment dropping by more than 3.2 million this year, according to health organizations. Georgetown analysis. In September, the U.S. Department of Health and Human Services announced Half a million children have regained coverage after the federal government worked with states to address renewal issues.
Olensky said the fight to keep August on Medicaid required “all the extra time.” It was time she didn't think she needed to spend.
“My son is an active brain tumor patient and is currently undergoing active treatment. If someone tells me it's a paper issue, I don't care, and they need to understand that. “There is,” she said. “That's not my job. My job is to be his parent and advocate. And I'm qualified to be his mother.”
