Erica Olenski, a single mother of three in McKinney, Texas, juggles the responsibilities of motherhood and her full-time job, plus the demands of work. brain cancer suffered by his 5-year-old child.
August was diagnosed in May 2019 and declared cancer-free the following year, but complications persisted. This September he relapsed and restarted his radiotherapy treatment, Olenski explained. About two months later, the letter arrived: the Texas Health Commission told him that August and one of his siblings were no longer eligible for Medicaid and would lose their insurance unless Olenski sent documents to verify his work history.
I had about three weeks before August lost coverage.
“Cancer treatment is stressful enough for a child. Pediatric cancer is horrible. “It’s absolutely horrible,” Olenski said. “And then for something like this, which really seemed like an administrative problem, to threaten our sense of stability and security while we were going through something that is really traumatic, it was horrible,” he lamented.
The disconnection after the pandemic
For August in particular, Medicaid was a lifeline: It covered the cost of radiation therapy and nurses to care for him 24 hours a day, Olenski said.
His family is one of many who, in the last eight months, have experienced the call “disconnection” from Medicaid. Since April, states have been reviewing enrollees’ eligibility for this program on a large scale, following a three-year pause in eligibility checks during the coronavirus pandemic.
Typically, people enrolled in Medicaid (government-provided health insurance for people with low income or disabilities) go through eligibility checks each year to determine if they can renew coverage. But in March 2020, the federal government froze verifications as part of its public health emergency. So people were continuously enrolled in Medicaid and no one was disenrolled for three years.
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That ended when President Joe Biden ended the emergency declaration for the pandemic in the spring. Many months later, Medicaid enrollees across the country continue to receive letters like Olenski’s as part of the “disengagement” process, which is scheduled to continue until May 2024. After that, the status quo prior to the pandemic.
Until December 20, at least 13 million people had been canceled from Medicaid in 2023, according to an analysis by KFF, a nonprofit group focused on health policy. Net enrollment in the program (as some people recently enrolled or re-enrolled) has dropped by about 7.8 millionaccording to an analysis by the Georgetown University Center for Children and Families.
“This is huge. We have never seen a decrease like this,” said Joan Alker, executive director of the aforementioned center.
Just over 70% of Medicaid withdrawals in states with available data were due to procedural reasons, such as lack of documentation, the KFF analysis found.
Losing coverage can have life or death consequences.
“For someone who has a chronic illness or disability, a break in coverage can cause their existing medical condition to significantly worsen,” said Jaeson Fournier, CEO of CommUnityCare Health Centers, a federally qualified health center in Austin, Texas, with clinics offering free and low-cost care.
“We know with great certainty that people who lack access to insurance, including Medicaid, will avoid necessary health services due to cost,” he added.
The ‘ground zero’ of disconnection
Texas is the zero zone of eliminating Medicaid, Alker said. That state leads the way in membership declines, with around 1.7 million this year, according to KFF. As of late November, nearly 990,000 renewal applications in the state had been denied on procedural grounds.
Daniel Tsai, director of the Medicaid and Children’s Health Insurance Program Services Center, said his staff met with Texas officials to study the state’s eligibility assessment process and review cases in which people had lost Medicaid.
“We demanded that you reinstate more than 90,000 people who had been incorrectly terminated from the program,” Tsai said.
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The Texas Health and Human Services Commission told NBC News in a statement that it “planned this massive cancellation effort for more than a year” and that if problems arise, the commission “systematically works to resolve any issues and restore beneficiary coverage if necessary.”
Tsai said that during the pandemic, Medicaid enrollment grew to record levels. So now, the rollback process requires an “unprecedented level of effort” as states try to catch up, she added.
“We’ve never had 97 million people in the program,” he said, “and we’ve never tried to do this (review) all at once.”
Olenski, who works in health care communications, spent what he called a “defeating” few weeks calling social workers and state agencies — anyone who could help — in an attempt to keep August’s Medicaid coverage. On December 1, he said, they briefly abandoned him. But the Texas Health Commission restored his son’s coverage the same day.
In a statement, the commission said it “did not receive a renewal application in time to again determine eligibility for continued Medicaid coverage” for August.
“The commission takes every step possible to provide benefits to eligible Texans as quickly as possible,” the statement adds, “we have taken several steps, including leveraging technology and standardizing on-the-job training, to improve the eligibility process.” .
However, Marisol García, financial assistant for CommUnityCare Health Centers, said some people have lost their Medicaid benefits without even realizing it.
“We’ve seen a lot of patients who have no idea their Medicaid has ended,” Garcia said, “We’ve been constantly busy the whole time.”
Children have been the most affected
Children have been significantly affected by the reduction: net enrollment of children in Medicaid decreased by more than 3.2 million this year, according to Georgetown University analysis. In September, the federal Department of Health announced that half a million children had regained coverage after the Biden administration worked with states to address renewal processing issues.
Olenski said her fight to keep August on Medicaid required “every ounce of extra time” she had, hours she doesn’t think she should have had to spend.
“My son is a patient with an active brain tumor who is undergoing active treatment. If someone tells me it’s a paperwork issue, I don’t care, so they have to figure it out,” he said, “that’s not my job. My job is to be his mother and advocate, and I deserve to be his mother.”
