Louisiana Illuminator

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

Published

9 months ago

August 25, 2023

Staff Editor

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Those removals happened due to an incomplete renewal process, whether because of missing paperwork, outdated contact information or a renewal form not sent by a specified date.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

Gambling on a constitutional convention • Louisiana Illuminator

Published

17 hours ago

May 16, 2024

Staff Editor

lailluminator.com – Robert Collins – 2024-05-16 09:31:15

by Robert Collins, Louisiana Illuminator
May 16, 2024

Louisiana Gov. Jeff Landry recently requested that the Legislature call a constitutional convention. He says the current constitution is too restrictive, and forbids cuts to most agencies, resulting in most cuts falling on higher education and healthcare. He also says that most of the amendments in the constitution should be statutes that can be changed by the state Legislature.

The enabling legislation that made it out of the House proposes to hold a two-week convention starting Aug.1, with convention committees meeting prior to the convention to receive public comments.

The current Louisiana constitution is a flawed and excessively-amended document and should be rewritten at some point. However, the legislation being sent over to the Senate for debate is setting up a rushed, high-risk process that makes it difficult for ordinary citizens to have their voices heard. It would increase the influence of the governor by giving him more discretionary power over how state money is spent, but it's unclear how it would help ordinary citizens.

The first problem with current convention legislation is the lack of public input. The constitutional convention of 1973 had a long series of open meetings that stretched over an entire year. Meetings were not only held in Baton Rouge. Committee members traveled to all parts of the state to make sure that any citizen who wanted to participate in a public meeting received the opportunity.

The 1973 convention was composed primarily of elected delegates. Some were state lawmakers, some were local officeholders, but many were simply private citizens who chose to run for a delegate seat. The current legislation calls for a convention of strictly state legislators and gubernatorial appointees. It's not really a recipe for broad public participation.

This is especially problematic for the urban areas of the state. The main protection that a city such as New Orleans, a heavily Democratic city in a Republican state, has is a home rule charter. The central structure of city government is shielded from state interference by the home rule charter rights written into the constitution. A hostile group of delegates could weaken the home rule charter provisions in the document. They could choose to change the form of government of the city altogether, taking away the power of the mayor and City Council to appoint members of city boards and commissions, such as the City Planning Commission or Sewerage & Water Board, and give those powers to the state.

The governor's legislative floor leaders have responded to criticism that the time period allocated to write a new constitution is too short to allow broad public participation by describing the new constitution as a refresh or a streamlining. They argue that their goal is not to write a new constitution from scratch, but simply to remove all of the provisions that should be legislative statutes. Their stated plan is a “limited convention.”

There is no such thing as a limited convention. There is nothing in Louisiana law that would stop delegates from immediately expanding the scope of the convention once they go into session. History indicates that governors and legislative floor leaders usually lose control of these conventions.

Veteran political journalist Jeremy Alford, in his book, “The Last Constitution,” said that the last time the state wrote a new constitution, in 1973, newly-elected Governor Edwin Edwards ran on a very specific set of constitutional reforms. Since Edwards was a popular and powerful governor, everyone expected the delegates to follow his charge. Alford said: “The delegates, however, ignored that charge and penned a plan for drafting their own constitution on the back of a cocktail napkin from Pastime Lounge, which in turn became one of the first official documents entered into the convention record.”

Given the high stakes of getting this convention wrong, it is time for the Senate to slow the process down, stretch it out, schedule public meetings across the state, and bring more private citizens into the process.

Ultimately, the voters will have the final say because a new constitution must be approved by a simple majority in a statewide vote. It would be preferable to bring broad public participation at the start of the process rather than waiting until the end. Rushing the process and excluding most of the voters runs the risk of dealing the state a losing hand in the end.

This article first appeared on Verite News and is republished here under a Creative Commons license.

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. 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

Ranked-choice voting close to being illegal in Louisiana • Louisiana Illuminator

Published

1 day ago

May 15, 2024

Staff Editor

lailluminator.com – Wesley Muller – 2024-05-15 18:28:24

by Wesley Muller, Louisiana Illuminator
May 15, 2024

Louisiana House lawmakers approved a bill Wednesday to outlaw ranked-choice voting, a method of elections they claim is too susceptible to fraud even though thousands of military members have used it for decades.

Senate Bill 101, sponsored by Sen. Blake Miguez, R-New Iberia, passed the House in a 74-22 vote and will return to the Senate for concurrence before heading to Gov. Jeff Landry, who is expected to sign it into law.

The vote fell mostly along party lines with every Republican voting in favor of the proposal and most Democrats voting against it except for Reps. Roy Daryl Adams of Jackson, Marcus Bryant of New Iberia, Robby Carter of Amite and Steven Jackson of Shreveport.

Miguez's bill prohibits local governments from holding ranked-choice elections, with an exception for out-of-state military members who have used it in Louisiana elections for decades.

Ranked-choice voting, also called “instant-runoff” voting, allows voters to list candidates in order of preference rather than select just one. It has grown increasingly popular across the country for its ability to temper extreme partisanship and give moderates and third-party candidates a better chance in elections.

When ballots are tallied on Election Day, the race is over if any candidate nets more than 50% of the first-place votes that are cast. If no candidate gets a majority in the first round, then the candidate with the fewest votes is eliminated. If a voter's first choice is eliminated, rather than his vote being wasted, it is applied to his second favorite candidate. The process continues with the lowest ranking candidates being tossed out until one candidate gets more than half of the votes.

During committee hearings on the bill, Miguez falsely claimed ranked-choice voting “guarantees that ballots are thrown in the trash.” It echoes national lobby groups that have blamed ranked-choice voting for helping defeat their preferred candidates and are now trying to get states to ban it.

Miguez's arguments against ranked-choice voting lean on misinformation

Military service members stationed out of state or overseas have used ranked choice to vote in Louisiana elections with no issues since the 1990s. There has never been evidence that their ballots have been disposed of without being counted as Miguez claimed.

Rep. Beau Beaullieu, R-New Iberia, presented the bill to the House floor Wednesday on behalf of Miguez, claiming ranked choice disenfranchises voters. He was unable to offer specifics when House Democrats pressed him on the claim and asked why, if the claim is true, has it never disenfranchised Louisiana's military voters.

Miguez's bill is part of Republican Secretary of State Nancy Landry's legislative agenda. Landry has argued ranked-choice voting can sometimes be complex and confusing, which is believed to have been the case in some elections.

An analysis of a 2004 ranked-choice election in San Francisco found that it might have led to lower engagement among African Americans, Latinos, less educated voters and those whose first language was not English, according to the Alaska Policy Forum.

However, other states and municipalities report success with ranked choice. Polling after the 2021 election in Utah found 86% of voters liked the system, and 81% said it was easy or somewhat easy to use, according to the Salt Lake Tribune.

Ranked-choice voting is used in more than 50 cities across 14 states. Colorado, Nevada and Oregon are on track to consider adopting it this year for statewide elections. It is even credited with helping Republicans break a decade-long losing streak in Virginia with the 2021 election of Gov. Glen Youngkin.

Like Miguez's bill, legislation in four other southern states seeking to ban ranked-choice voting includes exceptions for overseas military voters.

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