Isabella’s parents have been puzzled for five months as Isabella still hasn’t had her Medicaid reinstated, while her brother, who is in the same family with the same income, never lost his coverage. Dr. Laura Luzietti, the executive director of Every Child Pediatrics, where Isabella receives primary care, expressed confusion over the situation, stating that something seems to have gone awry.
Luzietti mentioned that the Quintanas’ struggle with Medicaid is not uncommon, with many families facing similar challenges. When families inquire with enrollment specialists, they are often informed that the situation is indeed strange and that the coverage should be restored in a few months. However, even a few months without coverage can have significant repercussions for the young children affected.
Isabella Quintana, accompanied by her family, has gone without Medicaid coverage for five months, unlike her brother who has maintained his health insurance. Isabella appears to be caught up in the aftermath of a significant Medicaid re-evaluation resulting from the end of the Covid public health emergency. During this process, over 25 million people lost coverage due to procedural issues such as paperwork problems.
By March 2023, nearly 40 million children were enrolled in Medicaid or the Children’s Health Insurance Program. However, as of August, over 5 million fewer children were enrolled, and it remains uncertain how many of them are still eligible for coverage. Joan Alker, the executive director of the Georgetown Center for Children and Families, noted that many children who lost coverage should still be eligible for Medicaid, but the unwinding process has left them without proper insurance.
Alker highlighted the disparities in how different states managed the Medicaid re-evaluation, with some states protecting children effectively while others, such as Texas, Utah, Colorado, and Florida, saw significant numbers of children losing their coverage. The unwinding process also led to a backlog of paperwork in many areas, prolonging the consequences for children like Isabella.
Kim Bimestefer, the executive director of Colorado’s Department of Health Care Policy and Financing, emphasized the importance of promptly restoring coverage for individuals affected by paperwork mishaps. In Colorado, the unwinding process caused safety net enrollment to drop by over 30%, resulting in more than 550,000 people losing their insurance coverage, including nearly 150,000 children. efforts are underway to locate and reconnect those who fell through the cracks.
On average, coverage was restored as per the state’s guidelines. Some individuals transitioned to employer-based insurance as the economy improved post-pandemic. However, Bimestefer acknowledges that the uninsured rate in the state has increased since the unwinding period began. She emphasized the importance of every American having health insurance, highlighting the challenges families face when transitioning from Medicaid, where they had no premiums, deductibles, or copays, to the reality of private insurance. Colorado is actively working to connect people with the coverage they are eligible for.
The state has implemented new processes to expedite reviews and is leveraging automation to address the backlog. Yet, the changes are not happening quickly enough for many families. At Every Child Pediatrics, a significant number of patients lost Medicaid coverage, leading to a rise in uninsured patients seeking care. Many uninsured individuals are avoiding necessary medical services due to concerns over costs, potentially impacting their long-term health outcomes.
Desiree Wines shared her experience regarding her son Jibreel, who has autism and lost his Medicaid coverage suddenly, resulting in the cancellation of vital therapies. Despite eventually regaining coverage, the disruptions had lasting effects on Jibreel’s care. Wines also faced challenges obtaining a special safety bed for Jibreel, as Medicaid no longer covered it upon reinstatement. The lack of consistent coverage has forced Wines to take extra precautions to ensure Jibreel’s safety.
NBC News questioned the Biden administration about the federal government’s role in safeguarding eligible families during the Medicaid unwinding process. Medicaid, jointly funded by the federal and state governments, saw states managing redeterminations while the federal government provided oversight. Tsai from the administration expressed empathy for the families affected by these transitions, emphasizing the need for a smoother process to prevent such hardships.
The director stated, “There are instances in which the state has acknowledged errors, prompting us to demand corrective action, such as covering all medical expenses and addressing all related issues. However, regardless of these cases, it is evident that there are systemic failures leading to excessive bureaucracy and difficulties for parents, families, and individuals who are rightfully eligible to navigate the process.”
Tsai emphasized the significant autonomy that each state possesses in managing its Medicaid program. This includes decisions on investment in streamlining eligibility procedures, the utilization of technology for verifications, and the adequacy of call center staffing. Such state-level determinations have resulted in markedly varied outcomes.
“There are specific regulations governing the federal government’s authority to impose requirements on states,” Tsai affirmed. “Our primary recourse, utilized in all instances of intervention, has been to issue a stern warning: ‘Failure to rectify the situation, reinstate coverage, and address issues will result in substantial financial penalties utilizing federal funds.’ This stance has been consistently enforced.”
Some advocates express concerns about the potential for further reductions in Medicaid coverage under the incoming administration of President-elect Donald Trump. During his previous tenure, there were repeated attempts to diminish Medicaid provisions. However, in a recent interview with NBC’s Kristen Welker on “Meet the Press,” Trump declared that entitlement programs would be safeguarded from budget cuts this time: “I won’t do it.”
Meanwhile, healthcare providers caution that the repercussions of healthcare restructuring may not be fully comprehensible for years to come. “The prevalence of chronic illnesses in adults poses a significant financial burden on the system,” Luzietti remarked. “Restricting healthcare for children, particularly essential preventive services crucial for their healthy development into adulthood, exacerbates the existing issues.”
In the immediate context, children like Isabella and Jibreel are already grappling with the aftermath of coverage disruptions. Isabella’s parents continue to await the reinstatement of her benefits after five months, apprehensively hoping that no further health emergencies arise. Even after children regain their coverage, challenges persist. Jibreel endured over five months without crucial speech therapy when his Medicaid coverage was terminated. Although his Medicaid has now been reinstated, his mother disclosed that he remains on a waiting list to resume therapy sessions.
