To prevent gaps in coverage during Covid, the federal government ordered state health agencies to automatically renew all Medicaid recipients. “For people who lost their jobs in the beginning of the pandemic, and then signed up for Medicaid, it helped a lot with keeping money in the household,” says Meredith Buhalis, program manager for the Washtenaw Health Plan, a county agency that helps uninsured residents get medical coverage. “It kept people healthier by maintaining access to prescriptions, doctors, and Covid-related health services.”

Some will be knocked off the rolls because their income and family size no longer meet the requirements, says WHP’s Jeremy Lapedis. But others will lose coverage because they can’t navigate the state’s complex and inefficient renewal process. | Photo: Mark Bialek

Medicaid insures households with incomes up to 138 percent of the federal poverty level, or $41,400 for a family of four. There’s a constant “churn” as income or family changes move households across that threshold. With automatic renewal, however, households whose circumstances improved were not removed, and new households who qualified continued to be added. As a result, enrollment in Washtenaw County rose from 53,636 to 75,725 people, with 19,000 residents remaining uninsured, according to Jeremy Lapedis, executive director of the WHP.

In April, health agencies were ordered to resume the annual review process. Michigan’s Department of Health and Human Services (MDHHS) is now contacting more than three million state Medicaid recipients for current income and family size information to determine if they’re still eligible.

Local figures aren’t available yet, but statewide about 472,000 cases were under review in June and July. As the Observer went to press, just over half had been resolved. Of those, about 19,000 were deemed ineligible, and another 4,000 were dropped for failing to submit the required documentation in time.

Lapedis estimates that between 7,000 and 18,000 county residents are at risk of losing coverage. Some will be knocked off the rolls because their income and family size no longer meet the requirements. But others will lose coverage because they can’t navigate the state’s complex and inefficient renewal process.

 “Many people moved during the pandemic—a move which was more likely for someone who was low-income and lost their job and needed Medicaid,” Lapedis explains. And people don’t always report their new addresses. Some can be tracked down via credit reports, but people with no credit history may never receive their requalification packets at all.

And even many who do receive the packets find them confusing. Lapedis says some notices are addressed to the wrong person in a household, or multiple people in a household receive individual packets even though households are supposed to receive only one. The legal language is complex, and the MDHHS website is hard to navigate. “Broadly speaking, the public benefits system that we have is designed to keep people from their benefits, as opposed to helping them access their benefits,” Lapedis emails.

Buhalis says MDHHS is “trying very hard to avoid what’s happened in other states, where hundreds of thousands of people have been removed from Medicaid for procedural reasons” when they didn’t get their documents in on time. Where income and family status can be confirmed from other sources, many recipients have been “passively reenrolled,” without having to submit paperwork. But the agency is understaffed and unable to respond to a flood of questions from confused recipients, instead relying on hospitals, clinics, and organizations like WHP for support.

“Health insurance is really stressful because you don’t know when you’re going to get sick, and you don’t know how much it’s going to cost,” Lapedis says. “It’s really complicated, what’s covered and what’s not. So [when] you lay the bureaucratic process on top of that, and I don’t know what to do to renew so I have health insurance when I need it—it’s challenging.”

The WHP is a rare example of an agency that helps people to fill out their Medicaid renewal application, or find different insurance if they are denied. Before the pandemic, WHP helped 3,500 people a year with Medicaid applications and renewals. Lapedis expects that number to rise significantly over the coming year. WHP also helps people find plans on the health care marketplace, and offers health benefits to a small number of people who don’t qualify for any other plan. Lapedis says anyone who needs assistance finding a plan can call the agency at (734) 544–3030.

“Most of the time we are able to help figure things out,” he says. “I would say that before they get to our office they are super-anxious and super-worried, and the majority of time when they leave our office they are saying, ‘Thank you so much, this is a huge weight off my chest.’”

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Calls & letters, October 2023

To the Observer:

Thanks for your article on Medicaid requalification (“Health Care Crunch,” Inside Ann Arbor, September). I had two minor corrections, and one update.

First, the Washtenaw Health Plan has changed its name to the Washtenaw Health Project to reflect that we are more than a county health plan—we provide comprehensive access to healthcare and health promoting services (updated website is WashtenawHealthProject.org). And second, to my knowledge, credit reports are used to verify identities to give people access to their Medicaid accounts online, but not to find updated addresses.

Finally, updated Medicaid data from June was released at the end of August. About 40 percent of people reviewed in June lost coverage. If it continues at this rate, about 1.2 million in the state of Michigan, and about 29,000 in Washtenaw County, would lose coverage this year—this is higher than I had previously thought.

Sincerely,
Jeremy Lapedis
Washtenaw Health Project