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Louisiana Illuminator

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Those removals happened due to an incomplete renewal process, whether because of missing paperwork, outdated contact information or a renewal form not sent by a specified date.

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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Landry removes job requirements, trumps local authority for industrial tax breaks

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lailluminator.com – Greg LaRose – 2024-02-22 05:00:54

Landry removes job requirements, trumps local authority for industrial tax breaks

by Greg LaRose, Louisiana Illuminator
February 22, 2024

Companies that receive major breaks on their local property taxes to invest in large industrial projects in Louisiana will no longer have to set hiring goals to get the incentive, plus they won't need approval from local taxing authorities if the governor is in favor of their proposal.   

Gov. Jeff Landry signed an executive order Wednesday that upends the standards and approval process that's been place for the Industrial Tax Exemption Program (ITEP) since 2016. The signing took place during the governor's appearance at a Louisiana Association of Business and Industry luncheon, according to the Baton Rouge Business Report

“This program is about capital investment. It is not about job creation,” Landry said.

Since 1998, Louisiana has awarded more than $20 billion in local tax breaks to industry through its Industrial Tax Exemption Program, according to an Ohio River Valley Institute analysis. 

Flow from the ITEP spigot slowed significantly in 2016 then-Gov. John Bel Edwards issued an executive order that required local approval of industrial tax exemptions. He also reduced the tax break available from 100% of property taxes to 80% and inserted a job-creation requirement for companies. Landry's order keeps the tax reduction at the same level.

The executive order he signed Wednesday also condenses the process for companies to receive local approval on their tax exemptions. Previously, each local body that collects property taxes had to approve tax breaks independently with a separate public hearing. For example, a parish school board could approve the tax exemption, but a parish council or sheriff could reject it. The business would then receive a partial tax break.  

Landry's new arrangement calls for a single parish industrial board, which would include representatives from the taxing agencies, to consider ITEP applications. Its vote would apply to all local agencies that receive property taxes, meaning companies would get approval a total tax break or none.

The executive order also upends the sequence of approval to award industrial tax exemptions, placing ultimate power in the governor's hands. Local approval has been necessary for an ITEP request to advance for consideration to the state Board of Commerce and Industry, a 24-member panel of appointees from business groups and the governor. 

Now, under Landry's order, companies will first submit their applications to the Board of Commerce and Industry. If their request is approved, the state panel will then notify a parish industrial board that it must hold a public hearing on the application within 45 days.

However, the order says little about what weight the local recommendation has in the ITEP approval process or how it factors into the governor's decision.

“Input from the Local ITEP Committee is important for consideration of an industrial tax exemption; however, it should not unduly delay the ITEP application process,” the order reads.

In an email, the Illuminator asked Landry spokesperson Kate Kelly about the governor's ability to override a local ITEP vote.

“The governor is the final say,” Kelly said.

Together Louisiana, a coalition of church and civic groups, has been highly critical of the state's generous ITEP giveaways. In a statement Wednesday, the group questioned whether Landry's order turned the incentive program into “a gift.”

“If a corporation gets a tax exemption, not to bring in a new plant or create jobs, but just as a public subsidy for its routine capital investments — investments, that is, that would have happened anyway — the result is not economic development. It's the opposite,” the Together Louisiana statement said. 

“In that scenario, local communities don't get new economic activity, but they still lose the millions in tax revenue from their schools, roads and police,” the statement continued. “They lose jobs — the teachers, construction workers, sheriff's deputies and others who would have provided the services that went unfunded. And their property taxes start going up, to fill the holes in the tax base left by each new round of gratuitous giveaway.”

Without any job requirements, companies can now apply for tax exemptions for most any large-scale investment in Louisiana. Landry's order does specify that maintenance expenses, environmental compliance upgrades and replacement parts that are not part of an extensive restoration do not qualify for ITEP awards.

The order goes into effect for all ITEP applications moving forward, effective Feb. 21, but does not apply retroactively to applications or exemptions.

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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 Twitter.

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Criminal justice reform advocates ask court to force Legislature to hear from public

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lailluminator.com – Piper Hutchinson – 2024-02-21 16:51:56

Criminal justice reform advocates ask court to force Legislature to hear from public

by Piper Hutchinson, Louisiana Illuminator
February 21, 2024

Three Louisiana criminal justice reform advocates have asked a state court to prevent the Legislature from discussing several proposals until more public testimony is heard on the bills. 

Their petition was filed Wednesday in 19th Judicial District Court in Baton Rouge by Norris Henderson, executive director of Voice of the Experienced, Ronald Marshall, chief policy analyst with Voice of the Experienced, and Erica Navalance, a staff attorney with the Promise of Justice Initiative. Read the full petition below. 

They contend House Administration of Criminal Justice Chair Rep. Debbie Villio, R-Kenner, has irregularly limited public input over two days of hearings during a special session on crime policy. The agenda for the session features a string of bills, with Gov. Jeff Landry's support, that call for harsher consequences for criminals.   

The committee enacted a rule to limit each public commenter to three minutes and cut off public debate after proponents and opponents of a bill each testified for one hour. The three-minute rule is a common practice at the Capitol, but overall time limits are seldom used. 

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Committee members said they supported these rules to get through testimony more quickly. On Tuesday and Wednesday, the committee had a full schedule of bills that attracted a large number of public comments. The special session doesn't have to end until March 5, but leaders have suspended the rules several times in order to expedite hearings on bills rather than letting them lay over for a day between hearings. 

House Democratic Caucus Chair Rep. Matthew Willard of New Orleans and other Democrats have criticized Republicans for fast-tracking legislation that would almost totally reshape Louisiana's criminal justice system, giving the public limited opportunity for input. 

The court petition seeks to prevent the full House of Representatives from discussing the bill until the House Criminal Justice Committee holds another hearing to allow more public comment. The complainants say they traveled to Baton Rouge to testify, but the committee's time limits prevented them from speaking. 

House Speaker Phillip Devillier, R-Eunice, defended the committee, arguing two hours of discussion per bill is reasonable, and that the Legislature is allowed to suspend the rules to advance bills. 

The complainants want to pause debate on four bills: 

House Bill 4, by Rep. Julie Emerson, R-Carenco, which limits post-conviction relief opportunities. House Bill 6, by Rep. Nicholas Muscarello, R-Hammond, which expands the methods by which Louisiana executes people and shields records related to executions from public viewHouse Bill 9, by Villio, which eliminates parole in almost all circumstances House Bill 10, by Villio, which limits good time credits and credit for time served

 

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 Twitter.

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Biden unveils latest round of student loan cancellation to aid 153,000 borrowers

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lailluminator.com – Jennifer Shutt – 2024-02-21 16:26:30

Biden unveils latest round of student loan cancellation to aid 153,000 borrowers

by Jennifer Shutt, Louisiana Illuminator
February 21, 2024

President Joe Biden expanded his push to eliminate student loan debt Wednesday, saying during a speech the initiative is part of a campaign promise to address the “broken” system.

“While a college degree is still a ticket to a better life, that ticket is too expensive,” Biden said. “And too many Americans are still saddled with unsustainable debt in exchange for a college degree.”

Biden, who made his remarks while on a trip to California that also included fundraising for his 2024 campaign, argued that canceling student loan debt not only helps those who receive the benefit directly, but those in their communities.

“When people's student debt is relieved, they buy homes, they start businesses, they contribute, they engage in the community in ways they weren't able to before and it actually grows the economy,” Biden said.

The latest round of student debt forgiveness includes nearly 153,000 borrowers and a total of $1.2 billion in debt, according to a fact sheet from the White House.

Those receiving loan forgiveness are enrolled in the Saving on a Valuable Education or SAVE repayment plan, have been paying back their loans for at least 10 years and originally took out less than $12,000 in loans.

This week's actions bring total student loan cancellation by the Biden administration to $138 billion for nearly 3.9 million people, according to the fact sheet.

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Repayments tied to income, family size

The so-called SAVE Plan allows borrowers to set their student loan repayments based on their income and family size, not the amount of student loan debt they hold.

“The SAVE plan ensures that if borrowers are making their monthly payments, their balances cannot grow because of unpaid interest,” according to the White House's fact sheet. “And, starting in July, undergraduate loan payments will be cut in half, capping a borrower's loan payment at 5% of their discretionary income.”

Education Secretary Miguel Cardona said on a call with reporters Tuesday there are about 7.5 million people enrolled in the SAVE Plan and that 4.3 million don't have a monthly payment.

“Many SAVE forgiveness recipients come from lower- and middle-income backgrounds,” Cardona said. “Many took out loans to attend community colleges. Some were at high risk for delinquency and default. That's why the actions we're announcing today do matter.”

Cardona said those eligible for this round of student debt cancellation would receive an email from Biden telling them about the move.

New FAFSA rollout criticized

Louisiana Republican Sen. Bill Cassidy said in a written statement the latest round of student loan forgiveness is misguided.

“The Biden Department of Education has been unable to fulfill their basic responsibilities mandated by Congress and essential to families, like implementing FAFSA,” Cassidy said, referring to the application college students fill out to access student aid, including grants, scholarships and loans.

The Biden administration's efforts to revamp the form have been marred by delays and errors. 

“Instead, they have spent a considerable amount of time prioritizing their student loan schemes to shift someone else's debt onto taxpayers that chose not to go to college or already paid off their loans,” Cassidy added. “This is unfair, manipulative and a cynical attempt to buy votes.”

Cassidy is the ranking member on the U.S. Senate's Health Education Labor and Pensions Committee, often referred to as the HELP Committee.

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Supreme Court decision

Biden, speaking at the Julian Dixon Library in Culver City, California, criticized the U.S. Supreme Court for blocking his original student loan forgiveness plan. 

“Early in my term, I announced a major plan to provide millions of working families with debt relief for their college student debt,” Biden said. “But my MAGA Republican friends in the Congress, elected officials and special interests stepped in and sued us. And the Supreme Court blocked it. But that didn't stop me.”

Biden said the justices' opinion in that case led him to “pursue alternative paths” for student debt relief, which includes the announcement he made Wednesday.

Canceling some student loan debt, Biden said, is about giving people a chance.

“That's all we're doing … giving people a chance, a fighting chance to make it, because no one who is willing to work hard in America should be denied the opportunity to have that chance.”

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 Twitter.

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