Syracuse, N.Y. – More than 13,000 Onondaga County residents could lose their Medicaid coverage over the next year.
That could happen because they are now making too much money to qualify for the health insurance program for the poor and disabled.
But they could also lose their health insurance simply because they’re unaware a renewal notice is coming in the mail. They may fail to answer requests from the government that require each Medicaid recipient to recertify in coming months.
The government halted annual eligibility reviews in March of 2020 when the Covid pandemic began. During the public health emergency, federal law prohibited state Medicaid programs from discontinuing anyone’s coverage because of income changes.
That grace period continued coverage for thousands of county residents, who depend on Medicaid for everything from prenatal and maternal care to nursing home care for the elderly.
Now, the yearly eligibility reviews are about to restart. Every single person receiving Medicaid will be checked over the next 14 months to make sure they’re still eligible for the program that provides health care for people with low incomes or disabilities.
If people on Medicaid don’t respond over the coming months to renewal letters from the county or state, they could be cut off from health care.
Medicaid patients might not discover their insurance has been canceled until they go to pick up a prescription and are turned away at a pharmacy counter.
“I think there are a lot of people who may not find out they’ve been kicked off Medicaid until they show up in an emergency room, a doctor’s office or in a pharmacy,” said Sabrina Corlette, a professor and health insurance expert at Georgetown University.
State and nonprofit groups are launching public outreach campaigns to prevent that from happening.
But it’s a gargantuan task.
The renewed scrutiny of eligibility comes at a time when the county’s Medicaid enrollment is at a record high. About 4 of every 10 county residents are enrolled in the free government health insurance program for people with low income and disabilities.
Since the pandemic began the number of Onondaga County residents on Medicaid has increased from 115,682 to 144,431, a 25% increase. During that same period the number of New Yorkers on Medicaid soared 26% to about 7.8 million. California is the only state with a Medicaid program bigger than New York’s.
Doing eligibility reviews of millions of Medicaid enrollees nationwide, and here, will be a challenging bureaucratic task for state and county employees.
People who qualify for Medicaid are sometimes hard to track down, experts say. That’s because some move often and don’t report their new addresses to Medicaid agencies.
The timing for some Medicaid enrollees could not be worse. Many of these same people just saw steep reductions in their monthly food stamp (SNAP) benefits. The government provided extra food stamp benefits during the pandemic to make up for food price inflation and other economic hardships. The extra help ended in March.
Now that the emergency is ending, the Medicaid eligibility reviews will resume in April and people whose income exceeds eligibility limits could be kicked out of the program starting in July.
About 13,600 county residents could be dropped from the program.
That estimate is based on a federal government study that predicts 9.5% of Medicaid enrollees nationwide will lose coverage even though many of them will still be eligible.
Sarah Hamersma, a Syracuse University professor and researcher, believes the number of Onondaga County residents who lose coverage will be less than that.
That’s because New York’s Medicaid and other public health insurance programs are more generous than those offered by many other states, she said.
Plus, New York’s eligibility review process will take place gradually, over 14 months.
“New York is trying to do this as slowly and painlessly as possible,” Hamersma said.
But no matter how carefully New York handles the review process, it’s inevitable some people will fall through the cracks and lose coverage even though they are still eligible, Corlette said.
Most people on Medicaid are unaware of the changes.
A recent national Urban Institute survey found 6 of every 10 Medicaid enrollees were unaware the government is about to start checking their eligibility again.
The New York Health Foundation, the Health Foundation of Western and Central New York and five other foundations have contributed nearly $1.5 million to help fund a statewide outreach campaign called “Keep New York Covered.”
That money has been parceled out to 29 nonprofit community navigator groups such as ACR Health in Syracuse that help people enroll in public and private health plans available on the state’s health insurance exchange.
Those groups will do outreach and marketing to raise awareness of the coming change and try to minimize the number of people who fall through the cracks.
“Health care is a human right,” said Jordan Bellassai of the Health Foundation of Western and Central New York. “It’s important that individuals in our community have insurance coverage so they can address health concerns when they first come up instead of waiting until something becomes more serious.”
In Syracuse, a health advocacy group is gearing up to help Medicaid recipients with the annual eligibility checks.
ACR’s staff will reach out to clients they’ve worked with in the past to see if they need help with the renewal process or changing insurance plans, said Megan Vadala, ACR’s director of insurance.
“We recommend that people reach out to us before their coverage ends so there is no lapse in coverage,” Vadala said.
The state’s health insurance exchange, known as New York State of Health, has also launched a communications campaign to get the word out about the renewal process.
Onondaga County has not yet contacted Medicaid enrollees about the change. It will mail them notices once it gets instructions from the state Health Department, according to Sarah Merrick, the county’s social services commissioner.
As part of the renewal process, the county is obligated to try contacting enrollees a minimum of two times if the first attempt is unsuccessful, Merrick said.
“We are using all the resources we have to obtain accurate addresses on Medicaid enrollees,” she said.
The county will handle renewals for about 50,000 Medicaid enrollees who are people with disabilities, nursing home residents, people over age 65 or individuals receiving home care. The state health insurance exchange is responsible for the remaining 93,144 county residents on Medicaid.
The state also will resume eligibility reviews of people enrolled in two other public health insurance programs: the Essential Plan and Child Health Plus. Those plans also have not been subject to renewal reviews since early 2020.
In Onondaga County, 11,601 adults are enrolled in the Essential Plan and 6,939 kids are enrolled in Child Health Plus.
The state and counties will mail out renewal notices on a staggered basis beginning in April and the review process will take 14 months.
The Medicaid income limits for non-disabled adults are $20,159 for one person and $27,214 for a couple. Many of those with incomes that exceed those limits may qualify for the Essential Plan, another state public health insurance program for adults ages 19 to 64.
The income limit for the Essential Plan is $29,159 for a single adult. There is no monthly premium.
Others no longer eligible for Medicaid may qualify for private plans offered through the state health insurance exchange. Although they will have to pay for that coverage, many will qualify for tax credits that lower monthly premium costs.
Some people who lose Medicaid coverage and are working may qualify for employer-sponsored health insurance.
James T. Mulder covers health. Have a news tip? Contact him at (315) 470-2245 or jmulder@syracuse.com
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