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Despite federal warnings, red and blue states aggressively cull Medicaid rolls

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lailluminator.com – Nada Hassanein – 2023-08-25 13:37:42

Despite federal warnings, red and blue states aggressively cull Medicaid rolls

by Nada Hassanein, Louisiana Illuminator
August 25, 2023

Despite federal warnings to slow down, both red and blue states have cut off Medicaid coverage for nearly 4 million people because they lack the proper paperwork. In at least four states, half of all the people who have lost coverage for any reason are children.

During the pandemic, the federal government directed states not to remove anyone from Medicaid, the joint federal-state health care program for low-income people and people with disabilities. But states were cleared to resume eligibility and paperwork checks starting April 1.

As of Wednesday, nearly three-quarters of the roughly 5.4 million Medicaid recipients who've lost coverage were terminated because of “procedural” reasons, according to an analysis from KFF, a health care policy research organization. (Results were based on the responses from 39 states and the District of Columbia.)

Those removals happened due to an incomplete renewal process, whether because of missing paperwork, outdated contact information or a renewal form not sent by a specified date.

This month, the Centers for Medicare & Medicaid Services (CMS) mailed letters to every state, saying long wait times and high procedural termination rates might violate federal regulations to keep those who are eligible enrolled.

The letters came weeks after federal officials raised concerns about overzealous efforts to purge the rolls and gave states extra flexibility to re-enroll patients. Some states, such as Maine, paused removals.

The process has proven confusing for many patients, such as those whose first language isn't English or those who don't have computers.

Children account for one-third of Louisiana's Medicaid roll removals

 

Experts and advocates say grassroots efforts are needed to reach former recipients and help people re-enroll, stressing that lack of coverage threatens the health of vulnerable communities, including people of color, who make up a disproportionate number of Medicaid enrollees, as well as rural residents and children.

Public health professionals know poverty often leads to poor health, and the pandemic impeded critical and preventive care.

“Care got delayed, screenings got put off, therapies got interrupted,” said emergency medicine physician Dr. Georges Benjamin, executive director of the American Public Health Association, an advocacy group that represents public health professionals. Now, “they don't have a mechanism to pay for their care. Their care is delayed even further.”

‘Across the board'

Texas has terminated coverage for more than half a million people, more than any other state, out of about 5.9 million Medicaid recipients, and 80% of them were removed for procedural reasons, according to the KFF analysis. About 408,000 Floridians have lost coverage out of about 5 million, more than half for procedural reasons.

Texas and Florida are Republican-dominated states that have declined to expand Medicaid under the Affordable Care Act, also known as Obamacare. But Democratic strongholds that have opted for expansion also have removed tens of thousands of people for procedural reasons. New Mexico (97%), Washington (90%), Connecticut (87%), Minnesota (85%), California (85%), Rhode Island (73%), Colorado (67%), Vermont (66%), Maryland (65%) and New York (53%) are among the 34 states plus the District of Columbia (90%) where more than half of people were removed for failing to file the proper paperwork.

California, New York and Washington state are among the states that have terminated the most people since April. In California, 255,000 people were removed from the rolls for procedural reasons. In New York, about 179,000 removals were procedural, and in Washington state, 247,500 removals were for administrative reasons.

 

Cadence Acquaviva, spokesperson for the New York State Department of Health, argued the KFF reports are a “snapshot in time” and don't reflect those who transitioned to other lower-cost state health plans established under the Affordable Care Act.

“It remains the Department's goal to maintain affordable, high quality health coverage for New Yorkers who qualify throughout the ongoing redetermination process,” Acquaviva wrote in an email to Stateline. She said as of July 31, more than 83,000 of the more than 300,000 people removed were found eligible for and enrolled in other health plans.

California state health officials assert they are following federal regulations. Residents who lost coverage through Medi-Cal (the state's Medicaid program) due to procedural reasons have 90 days to send missing information to the Medi-Cal office, a California Department of Health Care Services spokesperson said.

It's an injustice if somebody is denied just because of paperwork.

– Scott Anglemyer, Community Care Network of Kansas policy director

The department is “conducting outreach to Medi-Cal members, including vulnerable members, recently discontinued to assist them in completing their renewal” during the 90-day period, spokesperson Anthony Cava said.

When Stateline asked about New Mexico's high procedural removals rate, the state Human Services Department asserted it prioritized people “assessed as likely ineligible” during the first four months of unwinding, leading to a “higher number of procedural denials during these months,” spokesperson Timothy Fowler said in an email.

The agency also said it's working with managed care organizations and BeWellNM, the state health insurance exchange, to connect procedurally removed patients with lower-cost insurance options.

A spokesperson for Republican Gov. Sarah Huckabee Sanders of Arkansas — a GOP-dominated expansion state, where 77% of about 300,000 removals were procedural — told local media this week that the state has been abiding by state and federal law.

“[The Department of Human Services] is using every tool to ensure people who are eligible remain covered and working with those who are no longer eligible to get coverage through their job or the healthcare marketplace,” spokesperson Alexa Henning told the Arkansas Advocate.

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In a handful of states, most people were removed from the Medicaid rolls because they were no longer eligible, not for technical reasons. In Michigan, for example, only 17% of more than 23,000 removals were procedural. The state's Department of Health and Human Services said in a statement it has also simultaneously renewed enrollment for 121,000 recipients, and that it is reinstating people who remain eligible for the program but were removed for procedural reasons.

In Texas, where Latino households rank lowest in median household income, the state health department says it's working with community organizations to conduct outreach efforts.

“This includes sending notices, text messages and robocalls, hosting community renewal assistance events throughout the state as well as leveraging community partners to assist with outreach efforts. We're collaborating with health care providers, community organizations, and advocacy groups to reach a wide range of individuals who may be affected by the changes,” a spokesperson told Stateline in an emailed statement.

Sonia Lara, director of outreach and enrollment at the Texas Association of Community Health Centers, said her agency worked on Spanish radio ads to reach families and is getting the word out to patients to make a free appointment for help with health centers' staff.

“We aren't done with the messages,” she said. “We've been doing this for a long time. Outreach is part of our fiber.”

A report by UnidosUS, a Latino civil rights organization, found stark disparities in average wait times to Florida's Medicaid call center: The average English-speaking caller had to wait 36 minutes before being connected with a representative, compared with Spanish-speaking callers, who had to wait 2 1/2 hours on average. Similarly, nearly a third of Spanish-language calls were disconnected before the caller reached a representative, compared with just 10% of English calls.

 

The issue is problematic for households where adults and caregivers work multiple jobs, don't have the flexibility to wait on the call, or don't have computers to file applications online, said Andrea Vendetti, a senior program manager at the Clearwater, Florida-based nonprofit Hispanic Outreach Center. Many of her clients missed renewal windows and must reapply from the beginning, delaying care even further, she said.

In California, where about half of Medicaid recipients are Hispanic and roughly 30% are Spanish speakers, 53% of those removed from the rolls are Hispanic, according to data from the state's Department of Health Care Services. Earlier this month, two health care advocacy groups called on the state to ratchet up its outreach efforts.

“Language accessible information and culturally responsive trusted messengers must be prioritized to keep these populations enrolled in life-saving health programs,” said Dr. Seciah Aquino, executive director of the Latino Coalition for a Healthy California.

Children and rural residents

Of the 15 states that reported total removals by age group, Texas reported the highest percentage of children removed, at 81%, followed by Idaho, Kansas and Missouri, where at least half of those removed were children, according to KFF.

In Kansas, about 52% of Hispanic or Latino children live below 200% of the poverty level, compared with 27% of white children, according to the Annie E. Casey Foundation Kids Count Data Center. Pediatrician Dr. Gretchen Homan sees families in the Wichita area and said many of her patients need more support.

The clinic has a full-time translator and a social worker who is helping families navigate renewals. Nearly 80% of Homan's patients are on Medicaid, and many speak English as a second language or have complex health conditions such as cerebral palsy or autism.

One mother, whose children have chronic illnesses, told Homan she'd been awaiting renewal packets, only to find that the mailbox she shares with a neighbor was too full. Mail wasn't being delivered and instead was sent back.

“She said, ‘This is really hard, and my kids have been without their medicine for the last month,'” Homan recalled.

Because Kansas has not expanded Medicaid eligibility, “fewer members are able to be renewed through the passive process,” said Matthew Lara, communications and legislative affairs director of the Kansas Department of Health and Environment. Kansas is one of the 11 states for which KFF did not have a breakdown of how many removals were procedural.

“Expanding Medicaid would increase passive renewal rates, decrease the number of members who would be at risk for procedural termination, and decrease call volumes,” he wrote to Stateline in an email.

He also said the letter from CMS is based on data from May, and the Kansas department has since made adjustments to address concerns, such as adding a chatbot to the KanCare website, hiring more call center staff and allowing renewals when no income data is returned.

Community Care Network of Kansas, a coalition of community health centers that includes low-income and rural health clinics, provides outreach training to clinics' staff. The agency released social media renewal toolkits in English and Spanish for health centers to post on their social media pages and share.

“It's an injustice if somebody is denied just because of paperwork, just because of administrative things,” said Scott Anglemyer, the network's policy director. “That's not right, and that's not the purpose of government. The purpose of government is to help citizens thrive, and if we're kicking people off just because of administrative reasons, we're not helping them.”

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This article was first published by Stateline, part of the States Newsroom nonprofit news network with the . It's supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

Louisiana Illuminator is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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Louisiana Illuminator

After U.S. Supreme Court decision to allow bump stocks, U.S. Senate rejects bill to ban them • Louisiana Illuminator

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lailluminator.com – Ariana Figueroa – 2024-06-19 06:25:13

by Ariana Figueroa, Louisiana Illuminator
June 19, 2024

WASHINGTON — U.S. Sen. Pete Ricketts blocked a bipartisan bill Tuesday that would ban bump stocks following a Supreme Court decision that repealed a Trump-era rule against using the gun accessory.

Ricketts, a Nebraska Republican, objected to New Mexico Democratic Sen. Martin Heinrich's request that the chamber approve his bill — cosponsored by Nevada Democratic Sen. Catherine Cortez Masto and Maine Republican Sen. Susan Collins — by unanimous consent.

Heinrich attempted to pass the bill, which the trio introduced last year, following the Supreme Court ruling last week that the Bureau of Alcohol, Tobacco, Firearms and Explosives lacked the authority to ban bump stocks.

“As a firearms owner myself, there's no legitimate use for a bump stock,” Heinrich said. “What they are tailor made for is a mass shooting.”

The bill, S. 1909, would ban the sale of bump stocks that allow semi-automatic weapons to rapidly fire multiple rounds like a machine gun.

Ricketts argued that the Supreme Court made the right decision and said the bill didn't just ban bump stocks but also “targets other firearm accessories.”

Ricketts added that the bill is a violation of the Second Amendment.

“This bill is about banning as many firearm accessories as possible and giving ATF broad authority to ban most semi-automatic firearms,” Ricketts said. “It's an unconstitutional attack on law-abiding gun owners.”

Heinrich said the bill would not ban a large amount of firearm accessories, but would ban things like Glock switches, which can be attached to the side of a Glock handgun to convert a semi-automatic pistol into a fully automatic firearm.

“I think the American people understand what common-sense gun safety looks like,” Heinrich said.

Senate procedure requires 60 votes to proceed on most legislation. But for the chamber to approve a measure by unanimous consent, no senator can object.

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Supreme Court ruling

The Supreme Court on Friday overturned an ATF regulation, enacted during former President Donald Trump's administration after the Las Vegas mass shooting, which defined a semi-automatic rifle equipped with a bump stock attachment as a machine gun. Machine guns are generally prohibited under federal law.

In that mass shooting, a gunman used rifles outfitted with bump stocks to fire into a crowd of 22,000 people at a music festival, killing 58 people that night and two more who died of their injuries later, and injuring more than 500.

Senate Majority Leader Chuck Schumer said on the Senate floor that the bill was needed because the Supreme Court's decision was “an utter disgrace.”

“It will endanger our communities, endanger law enforcement, and make it easier for mass shooters to unleash carnage,” Schumer, a New York Democrat, said.

The opinion, written by Justice Clarence Thomas, who is a strong defender of Second Amendment gun rights, deemed that the ATF exceeded its statutory authority in prohibiting the sale and possession of bump stocks, which he said differed importantly from machine guns.

“Nothing changes when a semiautomatic rifle is equipped with a bump stock,” Thomas wrote. “Between every shot, the shooter must release pressure from the trigger and allow it to reset before reengaging the trigger for another shot.”

Additionally, the decision, which was split along ideological lines, limits the federal government's ability to address gun violence in the absence of congressional action.

More federal gun legislation unlikely

With a split Congress, any gun-safety related legislation is unlikely to pass. However, after Friday's decision, President Joe Biden called on Congress to ban bump stocks and assault weapons.

“Americans should not have to live in fear of this mass devastation,” Biden said at the time.

The last time Congress passed gun legislation was in 2022 after two mass shootings that occurred less than two weeks apart.

One was at an elementary school in Uvalde, Texas, where 19 children and two teachers were killed. The other was in Buffalo, New York, where a white supremacist targeted a predominantly Black neighborhood and killed 10 Black people.

The 2022 gun safety legislation did not ban any firearms but provided funds for mental health and to help states enact red flag laws, which allow the courts to temporarily remove a firearm from an individual who is a threat to themselves or others, among other provisions.

That same year, the Supreme Court decided on a major gun-related case that invalidated a New York law against carrying a firearm in public without showing a special need for protection.

Because of that decision, there's another gun-related case before the court that will test a federal law that prevents the possession of firearms by a person who is subject to a domestic violence protective order. A decision on that is expected this month.

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Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and X.

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Louisiana lags on electric vehicle charging program, but DOTD sees ‘no reason to rush’ • Louisiana Illuminator

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lailluminator.com – Wesley Muller – 2024-06-19 05:00:24

by Wesley Muller, Louisiana Illuminator
June 19, 2024

Two years after receiving federal funding to build electric vehicle charging stations across the state, Louisiana has yet to ask for bids from companies that might want the money. However, state transportation officials say there is a reason for their sluggish pace. 

The Louisiana Department of Transportation and Development (DOTD), plans to start the request-for-proposal process as soon as it identifies an appropriate “contracting mechanism” under state law to use the money, DOTD spokesperson Rodney Mallett said. 

The Federal Highway Administration allocated $73.4 million to Louisiana under the National Electric Vehicle Infrastructure (NEVI) program in 2022. NEVI is a product of the Bipartisan Infrastructure Law that Congress approved in 2021. It included billions for state transportation agencies to build a network of rapid chargers along major highways. 

Louisiana's initial response was on par with other states. DOTD submitted its NEVI deployment plan by the federal deadline of August 2022. However, while states such as Ohio, Pennsylvania and others now are disbursing the grant money or have already built some EV charging stations, Louisiana hasn't yet figured out how to spend it. 

“There's no real reason to spend two-plus years figuring out how to get this money to grant recipients when other states are already opening up chargers,” said Ryan McKinnon of the Charge Ahead Partnership, an EV charger lobby group. “Lots of states will be opening up chargers pretty soon, and it sounds like Louisiana will be sitting on the sidelines.” 

McKinnon said Louisiana is one of 11 states that have still not asked for bids to use the NEVI grant money. 

Some congressional Republicans and anti-union groups have directed their criticism at the Biden administration, claiming the delays are the result of mismanagement or of labor requirements within federal rules. Officials closest to the situation say the delays are largely because it is a new program that they want done correctly.

Mallet said the federal rules for the NEVI program don't “fit cleanly” within DOTD's usual contracting methods. DOTD often writes contracts for projects in which the agency owns and maintains the infrastructure, such as highways. In contrast, the EV charger grants will pay for the construction of infrastructure for which “ownership and operation will be transferred” from the state, in most cases, to a private entity, he said.

Although the Biden administration has aimed for a goal of building 500,000 charging stations by 2026, Mallet said the NEVI funds do not lapse, so there is no hard deadline to complete the projects.

“The key is to do it right for the long term,” Mallet said. “No reason to rush it through.”

States to receive $2.5B from feds for electric vehicle charging infrastructure

Tyler Herrmann with Louisiana Clean Fuels, a nonprofit working with DOTD on the NEVI rollout, said earlier, smaller EV charger programs saw build-outs at sites that weren't very practical. 

The chargers were often installed at public libraries or apartment complexes — places with no real interest or resources to maintain them. Without that routine maintenance, chargers would break and often stay that way for years. 

The government learned from those programs and is now taking care to avoid making those same kinds of mistakes, Herrmann said.   

“It is a unique situation,” Herrmann said of DOTD's efforts to administer the NEVI grants. “The program is pretty much completely different from what the DOTD does normally.”

In the meantime, Louisiana Clean Fuels has been working to build a workforce of technicians who can install and repair EV chargers and supply equipment.

Baton Rouge Community College just recently saw its first class of students graduate from a three-week course in which they learned some of the fundamentals required to become nationally certified Electric Vehicle Supply Equipment technicians. 

Herrmann said about a dozen students completed the first course, which will soon be offered at other community colleges across the state.

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Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and X.

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St. Tammany’s embattled coroner targeted under new state laws • Louisiana Illuminator

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lailluminator.com – Julie O'Donoghue – 2024-06-18 17:43:54

by Julie O'Donoghue, Louisiana Illuminator
June 18, 2024

Gov. Jeff Landry has signed two new laws to weaken the authority of St. Tammany Parish's controversial coroner who is already the subject of a recall campaign. 

Dr. Christopher Tape drew scrutiny from lawmakers after a WWL-TV investigation revealed he had been accused of child sex abuse in New Mexico decades ago and then settled a lawsuit over workplace sexual harassment allegations in the past few years. Charges in the New Mexico case were quashed after the prosecutor failed to move the case forward in a timely fashion. 

Almost immediately after taking office, Tape also tried to cancel a multi-parish program housed in the St. Tammany coroner's office that provides nurses to perform sexual assault exams on victims. The service helps police collect evidence and assists Northshore district attorneys who prosecute sex crimes. 

Legislators responded to Tape's actions, as well as his refusal to resign from his job, by filing legislation to limit his power.

Sen. Patrick McMath, R-Covington, sponsored a new law to give the St. Tammany Parish Council greater authority over the coroner's public finances and the ability to remove any coroner convicted of violent crimes. Moving forward, candidates for St. Tammany coroner must submit records regarding their criminal background to the local clerk of court.

Sen. Beth Mizell, R-Franklinton, authored a second law that allows the state attorney general to move sexual assault victim programs to another parish if the local coroner is unqualified or unwilling to perform those duties. 

In Tape's case, a transfer has already happened. Last month, the Jefferson Parish Coroner's Office took over the sexual assault examination program serving the Northshore region. The two parishes have entered into a cooperative endeavor agreement that allowed Jefferson Coroner Gerry Cvitanovich to hire the nurses who worked for the St. Tammany program.

Meanwhile, the organizers of Tape's recall must gather 35,000 signatures from qualified voters before mid-October for an election potentially forcing Tape out of office to take place.

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Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and X.

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