Medicaid review could drop 400,000 Michigan residents from coverage

• Emergency Medicaid coverage protection extended during the COVID-19 pandemic is set to expire April 1 
• Millions of people nationally are expected to lose coverage, including many who qualify but don’t fill out required forms 
• Coverage for 60,000 Michigan enrollees who depend on federal community health centers is also in jeopardy

In just two months, a bureaucratic review will begin that experts say could cost hundreds of thousands of low-income Michiganders their health insurance — and threaten nonprofit clinics that treat more than 400,000 Medicaid patients across the state.

Beginning April 1, more than 3 million Michigan Medicaid clients will have to prove they are eligible for benefits extended since 2020 under a federal health emergency that barred states from removing anyone from Medicaid during the COVID-19 pandemic. Michigan’s Medicaid ranks grew by more than 700,000 since the pandemic hit. 

Federal estimates calculate up to 15 million U.S. Medicaid enrollees could lose coverage during the benefits review, including 6.8 million people who could be booted from the rolls despite being eligible.

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In Michigan, the House Fiscal Agency projects upwards of 400,000 Medicaid recipients will lose coverage in the year after the benefits evaluation commences in April. And according to another analysis, more than 60,000 Michigan Medicaid recipients treated at federally-funded community health centers in the state could lose coverage even though they qualify for benefits, a health care research program based at George Washington University found. 

That could cost Michigan community health centers $50 million in annual revenue, the report calculated, and lead to the layoff of nearly 400 community health care workers, further diminishing healthcare access for low-income patients across vast stretches of the state. 

“We are concerned,” said Phillip Bergquist, CEO of the Michigan Primary Care Association, a Lansing-based nonprofit organization that supports the state’s network of community health centers.

While Bergquist said he is hopeful community health centers can stem the projected loss of Medicaid patients through patient outreach efforts, he said any loss of funding would hurt.

“There are large portions of the state where there is a general lack of health care, and community health centers play a really significant role in filling access to care in those communities. In rural areas of Michigan, a community health center is often the only local provider of primary care.”

Bergquist said Medicaid clients qualified for benefits could slip through the cracks for a variety of reasons. 

Some — because they changed addresses over the past few years — may not receive notification letters alerting them to their need to prove eligibility. Others, preoccupied with the day-to-day stresses of poverty, may simply forget it, or fail to comprehend it due to language barriers.

“It could be everything from ‘I got laid off at the beginning of the pandemic and so I Iet my lease go and moved somewhere else,’ or ‘I moved back in with my family,’” Bergquist said.

“Maybe they are sleeping on a friend’s couch or living in a shelter and they use a different address to receive their mail. It’s sort of a perfect storm of things that have happened to people.”

Indeed, an analysis of the looming Medicaid determinations by KFF, a San Francisco-based nonprofit health research organization, projected the redetermination  process would have the greatest impact on people who moved since the start of the pandemic, those with limited English proficiency and the disabled.

Federal projections are that children and young adults “will be impacted disproportionately,” with 5.3 million children and 4.7 million adults between ages 18 and 34 predicted to lose coverage. 

Medicaid enrollment grew by 20 million people nationally to 91 million since the start of the pandemic. 

In Michigan, Medicaid ranks have swelled by more than 700,000 since the onset of the pandemic, from 2.5 million in March 2020 to 3.2 million in December.  

That includes a rise of more than 350,000 Michigan basic Medicaid recipients, which covers families and children at or below the poverty level, the disabled and elderly, and an increase of 360,000 recipients enrolled in Healthy Michigan, the health care program for individuals and households earning up to 138 percent of the poverty level, or about $19,000 for an individual and $38,000 for a family of four.

The federal emergency order suspending annual reviews of recipients was meant to protect vulnerable individuals, families and children as the country confronted a raging pandemic that threatened people’s livelihoods as well as their lives. 

April 1 marks a return to the policy of individuals having to prove they qualify. And while officials fear many worthy recipients may lose coverage, there will many others who may have qualified for coverage at the onset of COVID but now earn too much to qualify.

State officials say they are taking sweeping measures to ensure that qualified recipients retain their benefits during a review process that is scheduled to take a year to complete. 

“The Michigan Department of Health and Human Services is strongly committed to providing access to Medicaid coverage,” spokesperson Bob Wheaton told Bridge Michigan in a statement.

“We have set up action teams to ensure a seamless and effective process to ensure that individuals who are eligible for Medicaid coverage remain eligible.

“We’re assessing capacity and supports for our local office staff and we’re in discussions with our health plans, local Community Mental Health agencies and other partners to be sure we have an overarching and all-encompassing strategy in place.  We will not know how many individuals will be eligible until the redetermination process begins, but the work we’re doing is to maximize coverage wherever possible.”

The state has launched public service radio ads warning of the impending Medicaid review process, part of a broader campaign that includes social media, text messages, mail and community partnerships as outlined in a 2022 MDHHS planning document.

The document notes the campaign will stress to beneficiaries that it is “critically important” to update their contact information, respond to letters “in a timely manner” and identify where they can go for help with their enrollment status.

In a wide swath of the rural northeast Lower Peninsula, Thunder Bay Community Health Service is about the only medical facility in the region for 17,000 patients spread across six counties. Through five community health centers, three school-based programs and a staff of about 200, it offers primary care, dental and pharmaceutical services as well as mental health support. It also staffs 22 area schools with mental health workers. 

“We are their safety net,” Thunder Bay CEO Michelle Styma told Bridge.

According to a University of Michigan analysis, the region, marked by high levels of poverty, already leads the state in the percentage of uninsured residents, in addition to high opioid use.

Styma said any interruption in Medicaid coverage would only add to its burdens.

“Patients in our community would be at a loss. They would be seeking care at the emergency room. They may not follow up on care they need. They may not opt to renew their medication. They are not going to seek care if it is coming out of their pockets.”

She added that staff workers are doing what they can to remind patients they need to pay attention to Medicaid renewal notices from MDHHS.

“We’ve been working on this for nine months. We’re doing what we can to get them re-enrolled, to get the care they need.”

In the meantime, private insurers and state medical and hospital officials are backing a plan that would cushion the potential impact of the Medicaid benefits review, by automatically enrolling clients removed from the rolls into healthcare marketplace plans offered under the federal Affordable Care Act. In general, those plans offer tax credits for individuals making up to 400 percent of the federal poverty level.

“There’s no better way to ensure continuity of coverage,” said Brian Mills, spokesperson for the Michigan Association of Health Plans (MAHP), a Lansing-based nonprofit that supports state private insurers.

Other states have already moved in this direction.

In Rhode Island, the 2023 budget allocates funds to automatically enroll qualified Medicaid clients who have been removed from the rolls into marketplace health insurance plans. The state is picking up the insurance premiums cost for the first two months.

“I believe in this initiative, which will remove barriers and keep families across Rhode Island connected to health coverage and the financial support that makes it more affordable,” Gov. Dan McKee said in a statement announcing the plan.

California is enacting similar measures, under which individuals losing Medicaid will be automatically enrolled in a low-cost marketplace plan.

In May, MAHP submitted a letter to MDHHS outlining its own enrollment plan, signed by officials from the Michigan Health & Hospital Association, an Ingham County-based hospital advocacy organization, the Michigan State Medical Society and the Michigan Primary Care Association.

“This is by far the most ideal way to meet your department’s objectives of minimizing healthcare coverage gaps and providing a seamless customer experience,” the letter stated.

But the plan needed approval from MDHHS and the federal Centers for Medicare & Medicaid Services (CMS) to go into effect.

Mills told Bridge on Wednesday that MDHHS had rejected the proposal, as officials said that federal officials “were not receptive to the idea.”