Lost in the Medicaid “cutback” shuffle. Kentucky suspends health care over clerical error – KFF Health News

The day her Medicaid coverage ended, Beverly Likens was in the hospital after a scary trip to the emergency room.

A Kentucky resident was diagnosed with severe anemia and received a blood transfusion after her hemoglobin levels dropped dramatically. Lykens, 48 ​​at the time, was days away from surgery to treat chronic uterine bleeding, which she said was causing “constant” bleeding.

But soon a problem appeared. the hospital said she didn’t have Medicaid coverage, jeopardizing her procedure. Lykens, who is disabled, was shocked by the news. He believed he had done what was necessary to maintain his competence. “I was just ready to fall to pieces,” Likens said, fearing that he would “spend the rest of my life on blood transfusions.”

Millions of people across the country lost Medicaid benefits after the pandemic-era coverage mandate expired in March, many of them for administrative reasons unrelated to their actual eligibility. Even the Biden administration and state officials had braced for complications from the historic relaxation of the continuous registration requirement and assured the public that they would guard against such loopholes.

Lykens and the attorney who tried to help keep his coverage said technological errors in Kentucky’s eligibility system and state missteps caused the gap in Lykens’ coverage, throwing his surgery into limbo. As her situation shows, even a few days off can have life-changing consequences.

The state should never have allowed Likens to become insured, said attorney Kara Stewart, director of policy advocacy for Kentucky Voices for Health. Stewart tried to file a new Medicaid application for Likens before her coverage was terminated in June. He got stuck in Kentucky’s online system, which “failed” and wouldn’t let the form go through. “I was just mad,” Stewart said.

Likens should never have reapplied for coverage, Stewart said, arguing that the state violated federal regulations that require states to consider all scenarios in which someone is ineligible before ending benefits. – who can qualify? Lykens, who has no children and does not work, should have qualified for Medicaid based on her income, which is below federal limits.

Medicaid, a safety-net health program run jointly by the federal government and states, covers millions of disabled people, pregnant women, children, adults without children, and the elderly. Often, a person who initially qualifies for Medicaid for one reason can remain eligible even when life circumstances change, as long as their income remains below certain thresholds.

Before losing coverage, Likens qualified for Medicaid because he had Supplemental Security Income, a program for people with little or no income or assets who are blind, disabled or at least 65 years old. Lykens has multiple chronic conditions, including diabetes, hypertension and heart disease, and said he initially enrolled in the program after his grandfather, who supported him financially, died. Likens was his guardian and did not go to college; After her death, she struggled with depression and anxiety, which she still manages with medication and therapy.

In addition to income limits, the SSI program limits beneficiary assets to $2,000 for individuals and $3,000 for couples. After the Social Security Administration told him in March that he was no longer eligible for SSI because he had assets whose monetary value exceeded federal limits, the Kentucky agency that oversees Medicaid sent Likens a notice in April. , which said his health benefits would automatically end at the end of the year. June.

The state did not assess whether he qualified otherwise, although Centers for Medicare & Medicaid Services regulations require states to consider all factors. Instead, Kentucky said he “may otherwise be eligible for Medicaid” and ordered him to reapply.

Kentucky health officials insisted they did nothing wrong. In a letter to the Kentucky Equal Justice Center, a nonprofit that provides legal aid, state officials said the requirement to consider whether someone qualifies for Medicaid under another category does not apply to people with SSI benefits. :

Because his Medicaid eligibility depends only on receipt of SSI, “the Department of Medicaid Services does not have sufficient information to determine whether an individual qualifies for another type of Medicaid assistance,” wrote Eric Friedlander, Kentucky’s health cabinet secretary. : and Family Services, and Lisa Lee, Commissioner of the Department of Medicaid Services. “Individuals receive clear guidance in the notice of application to determine whether they are eligible for other types of assistance.”

That explanation is “absolutely wrong,” said Elizabeth Priolx, senior legal fellow at the National Disability Law Network. “They failed on many levels.” Priolx pointed to policy guidance CMS issued in May that says if a person with SSI experiences a change in circumstances, states must reevaluate whether they otherwise qualify for Medicaid before ending coverage.

According to the Social Security Administration, there were 7.7 million SSI recipients as of 2021.

Spokespeople for the Kentucky Department of Health and Family Services did not respond to multiple requests for comment.

CMS regulations require states to first try to automatically renew people, a policy designed to help keep eligible people enrolled during what’s known as a Medicaid “discharge.” States can do this by verifying data sources, such as whether a Medicaid recipient is enrolled in other food and housing assistance programs, or by verifying federal and state income tax information. If that doesn’t work, states must send the registrant a renewal form asking for more information. Lykens said he never received one.

All states implement automatic renewals for at least some enrollees. However, states typically hold back on such renewals for some beneficiaries, including the elderly and disabled, raising the risk that someone could lose coverage when they shouldn’t, said Joan Alker, a Georgetown University children’s researcher. and Executive Director of the Center for Families.

“Given the high rate of procedural terminations, there are definitely people who qualify for another category, but they fall through the cracks,” Alker said.

After Likens was told to reapply for Medicaid, technological glitches in Kentucky’s online system left the application in limbo until his benefits ran out in June, Stewart said. The state contracts with Deloitte to operate its jurisdictional system; A company representative declined to comment.

In early July, after spending hours on the phone, Medicaid officials told her Likens’ coverage had been reinstated. But it wouldn’t show up in Likens suppliers’ computer systems for days. On July 10, he received an e-portal message from a nurse at Pikeville Medical Center that his insurance was listed as inactive and his surgery might be delayed as a result.

Lykens responded that the state told him he was “definitely approved for coverage” and that his renewed eligibility status “should be back active soon.” After repeated calls, Stewart said his reinstated Medicaid ran out in mid-July, and he had surgery on July 17.

Lykens recovered because his income was low enough. Kentucky expanded Medicaid under the Affordable Care Act, which in 2023 means a single adult without children must earn less than $20,120 a year to qualify. But he worries about others who are “not as fortunate as I am.”

“It’s not fair for any Kentuckian to have to go without health care,” he said.

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