Big Changes Coming to Medicaid Eligibility in New York
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Brian Lehrer: Brian Lehrer on WNYC. Now we'll do kind of a public service announcement and community share-your-experience call-in for people on Medicaid in New York State. Here's why this is newsworthy right now. As our health reporter Caroline Lewis reminds us, during the height of the pandemic, enrollment in Medicaid soared, increasing from about 6 million to 8 million New Yorkers. About half of New York City is on it. Many people lost income and employment but gained access to free public health insurance for the first time.
Now, over the past three years, with the COVID public health emergency in place, New York and other states stopped requiring people to renew their Medicaid coverage annually, so patients didn't face any scrutiny over whether they still qualified. Now that renewal process is starting up again and state health officials are going to be auditing the eligibility of millions of New Yorkers on a rolling basis over the next 18 months and potentially kicking thousands of people off of their current health plans.
They will also be checking eligibility for people on the Essential Plan and Child Health Plus, which are other forms of free public health insurance related to Medicaid. What I've heard is happening already in other states, and I will share a headline about that from this morning's news with you in a minute, is that people who do qualify to continue getting Medicaid health insurance are now sometimes losing that coverage. Why? Because they don't know that they have to renew and show their eligibility once again.
We don't want that to happen to anybody here, so we're going to tell you how to prevent it and also take your experiences with qualifying for or being on public health insurance plans in New York State. We are very happy to have with us now Amir Bassiri, New York State's Medicaid director, and Danielle Holahan, executive director of New York State of Health, which is the individual health insurance marketplace that's part of the Affordable Care Act or Obamacare in New York State. Director Bassiri, Director Holahan, thanks so much for being willing to help people out with this on our show in this way. Welcome to WNYC.
Danielle Holahan: Thank you so much for having us.
Amir Bassiri: Thank you, Brian.
Brian Lehrer: Director Bassiri, I just gave the basic situation in the intro. Correct anything from that if you need to or tell us more specifically who has to do what right now that they didn't have to do for the last three years.
Amir Bassiri: Absolutely. I think you summarized it pretty nicely, Brian. Essentially, there are 8 million Medicaid-enrolled individuals that will have to be redetermined for their eligibility. In addition, the Essential Plan population and Child Health Plus population, which bring us to a total of 9 million people, or half of the state, will also need to go through the Medicaid redetermination process for eligibility.
We have been preparing for this, as Danielle and I will outline, pretty extensively for the last three years and have taken several measures to ensure that people who are eligible maintain coverage, supported by actions to increase our eligibility limits to ensure continuity when we begin this process, which is now underway. To your point on things that are happening across the country, we are very hyperfocused on ensuring that that does not happen in New York.
Unlike other states, we have the luxury of having an integrated marketplace through the New York State of Health led by Danielle to ensure that that does not happen, but we do need people to act and be aware that they do need to respond to the notices they've received or reach out to the New York State of Health if they have any questions about when they should receive that notice.
Brian Lehrer: We'll continue to get into how people can do that, but here's an example of a news story that just dropped this morning from HuffPost on what's going on in other states. The headline is, "Biden administration begs red states to slow down their Medicaid purges." Then it says, "Large coverage losses in states like Arkansas and Florida have Democrats ringing alarms and threatening action."
Director Holahan, what I've seen in other reports on this is that, in many of these cases, it is in fact people who do still qualify for Medicaid, they just don't know that the renewal scrutiny process has started up again and then they get kicked off. How are you going to prevent that from happening in New York?
Danielle Holahan: As Amir said, we have been working for the past year to start to promote the fact that this is coming, get New Yorkers prepared. We've been running paid advertising, we've been mobilizing our enrollment assistors in the community, largely focused on providing us updated contact information so that we can reach people when it's time to renew. We've now flipped our messaging to letting people know when they hear from us, they need to act to renew their coverage. We're trying to get the word out.
We've been working extensively with health plans, with providers, but the on-the-ground enrollment assistors across community-based organizations are a key network in just really trying to spread the word so that nobody is surprised in New York, people do what they need to do when it's time. I think the other thing we're trying to do here in New York is maximize our ability to automatically renew people's coverage.
We, through the marketplace, have access to data sources, where we can check people's eligibility and, wherever possible, administratively redetermine their eligibility into coverage. We're really doing everything we can to make this a success story in New York.
Brian Lehrer: You want to make it automatic, but who do you consider the hardest-to-reach populations to the extent that people do have to show up and reapply to keep their eligibility verified, and how are you doing outreach to try to leave no qualified Medicaid recipient behind, Director Holahan?
Danielle Holahan: I think one of the groups that's hard to reach are those who are non-English speakers, and so our advertising is in multiple languages, our consumer education materials the same. But really importantly, our enrollment assistors, we have 7,000 certified enrollment assistors, they work in the communities, and they speak over 60 languages. Our customer service center, where consumers can call and do a phone renewal, can accommodate any language, so that's a key-- Of course, our partnerships with community-based groups who are trusted in the communities are really essential to this work.
We want everybody to know that this is coming and to tell their consumers or their members, their patients, that when you hear from the state about your renewal, you need to act. In the last three years, everybody's coverage was extended, which was wonderful, but now, people need to act again. The messaging is key, and we really want people to come back when we need them to let us redetermine their eligibility.
Brian Lehrer: Now, listeners-- Oh, go ahead, Director Bassiri, if you do want to add something.
Amir Bassiri: Yes, I did, Brian. To your point on the harder-to-reach or the more vulnerable populations, I just wanted to add that the federal government, and CMS specifically, has offered some regulatory flexibility with respect to some of the eligibility requirements that are typically in place. New York, along with many other states, has taken advantage of those flexibilities, which will enable us to automatically renew more people based on varying conditions, one of which is, if they have SNAP eligibility or if they have zero income, if they're aged, blind, and disabled and go to the local district to determine their eligibility, we are eliminating the resource test requirement.
We are trying to make it as easy as possible for those that we know there should be no reason for why they lose their Medicaid eligibility. As Danielle said, in addition to some of the outreach with the partners, we have taken advantage of extensive federal flexibilities. I think if we're not the number one state, but we are the number two state in terms of how many waivers we've received.
Brian Lehrer: By the way, for those of you who just heard a woman's voice in the background for a minute, it was when I called Director Bassiri by his name, and the last two syllables of that, Siri, set off my iPad. [chuckles] Maybe it's going to happen again now. Anyway, this is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are a New York and New Jersey Public Radio and live streaming at wnyc.org.
Listeners, we can take a few phone calls for the director of Medicaid for New York State, whose name I shall not say again right now, and the director of New York State of Health, that insurance marketplace. 212-433-WNYC, 212-433-9692. If you have questions about the renewal requirements starting up again now that the special pandemic provisions are ending or if you want to share your tips on that, listeners, or to share an experience or ask a question about the health coverage and health care you actually get from Medicaid and related programs, feel free, 212-433-9692.
We would also love to hear from doctors or other healthcare providers. Are you worried about losing patients and income if people lose their Medicaid or just worried about some of your patients who are currently in your practice for the reason that they may lose coverage? 212-433-WNYC, 212-433-9692. Director Bassiri, can you look back for a minute over the last three years? Maybe this is important to do. How do you assess the role or performance of Medicaid for New Yorkers during the pandemic emergency?
Amir Bassiri: I think it's a great question. I think Medicaid and specifically the public health insurance programs that we offer in New York State beyond Medicaid have been really lifelines for so many individuals and their families and been a safety net for those that were disproportionately impacted by the impacts of the COVID pandemic with loss of income or job loss. I do think New York is unique in the continuity and suite of health insurance products that we have, including the Essential Plan, and that we have avoided a lot of people having no access to care, including those that are not even Medicaid income eligible through the Essential Plan and Child Health Plus.
It has been a fascinating three years, very stressful three years, but we have really had our own little experiment with respect to no churn in Medicaid, which is part of the problem with the reinstatement is that there is expected to be some churn again, meaning people will come off and likely come back to us at a later point when they need health care. Our goal is to make sure that no one loses access to care, loses continuity of services to the extent they're receiving care today.
We know that the benefits of those being covered has been extensive as evidenced by some of our patient satisfaction and consumer satisfaction reports. We've also seen improvements in quality in certain instances, and so it has been very, very critical for us and sort of reiterated the importance of the Medicaid program, as well as the other public health insurance programs like Child Health Plus and Essential Plan.
Brian Lehrer: Let's take a phone call. Here's Harry in Forest Hills. Harry, you're on WNYC. Hello.
Harry: Hi, how are you? Just a couple of quick comments and things that I noticed with the neighbors that if you're on Medicaid and you go to another state, other states have different Medicaid, so you may not get the same coverage. Also, I know there is a money cap, and I have another neighbor who every now and then with her pension and Social Security goes over the allowable cap. I think it's like $950 for New York, it's like a poverty line, as opposed to Chicago, which has $1,170. That also would answer anyone who's saying, "Well, why is my money going to help someone else's health?" You're not getting the best care.
Also, under Governor Cuomo, he reduced payments to doctors, and doctors are not obligated to take Medicaid patients. That created a running away. I'm with First Health, which is a New York City or New York State-developed insurance, and I believe they are looking to go into Florida and California, which are other populous states and states which have seniors. The most important thing is if you are looking to flee New York and you have a low income and you have a medical or a disability issue, you should look into what that state offers because--
Brian Lehrer: Because it may not match. Harry, you put a few issues on the table. I'm going to leave it there. I appreciate it. Director Holahan, do you want to reply to any of that, including declining reimbursements, which might wind up having doctors have the incentive to not give the best care or try to pack more people into an hour in their practice, as he says was signed by Governor Cuomo? You tell me if that's accurate.
Danielle Holahan: I can let Amir speak to the provider reimbursement rates in Medicaid. I will agree with Harry on the state-by-state eligibility levels vary in New York. In addition to our Medicaid program, we also cover, as we've mentioned a few times, individuals up to twice the poverty level or $29,000 a year for an individual in our Essential Plan, which is very different.
That's an option under the Affordable Care Act called the Basic Health Program that only two states have taken, but we are here uniquely positioned to transition individuals who move or whose incomes may have increased above the Medicaid levels but now move into the Essential Plan. I think you're right, every state is different, but New York has taken some options here to ensure that our consumers have access to affordable coverage up to higher income levels.
Brian Lehrer: Yes. On the continuing back and forth between New York and Florida on which is the better state to live in and who's moving to where for what reasons, Florida, as you may have heard, listeners, was singled out in that HuffPost article as an example where there's a big Medicaid purge going on now that the pandemic emergency has expired. This purge is the word that HuffPost used in that article. Emmett in Brooklyn, you're on WNYC. Hi, Emmett.
Emmett: Hi, how are you?
Brian Lehrer: Good.
Emmett: I have a question. I was fortunate enough to be on Medicaid when I was in graduate school and just by chance have been staying on Medicaid because of the pandemic. When I look at my New York State of Health portal, it says that I have coverage continued until the end of April in 2024. I'm in a tough situation where my employer doesn't offer insurance nor do I make enough to forward it through the marketplace. My supervisor is hoping that can change, but I'm wondering, do people have to worry about getting kicked off of enrollment before their enrollment period ends?
Danielle Holahan: I'm glad you raised that. New York is taking the full 12 months to redetermine people's eligibility, so if your coverage runs through April, you don't need to act until April or the month prior. It is important that you mentioned that. We're taking this in cohorts. We're taking roughly one-twelfth every month of our 8 million enrollees across programs and renewing them one month at a time. Good point. People can check their coverage end dates through the New York State of Health portal as you did and see when it's their turn to renew, but your coverage is sound up until your renewal date.
Brian Lehrer: Emmett, I hope that's reassuring. Yes, and I had said in the intro, but it's worth repeating again, as you were just indicating, this is being done, this recertification process for your Medicaid eligibility, everybody, over the next 18 months. It's not all at once. You just heard Director Holahan describe how they're rolling it out in cohorts, a month at a time. Scott in Astoria, you're on WNYC. Hi, Scott.
Scott: Hi, how are you? Can you hear me?
Brian Lehrer: I can.
Scott: Okay. The process is really, really difficult for people who are self-employed because basically, you have to tell them how much you're earning, but you also have to tell them what your deductions are. Now, how am I supposed to know from month to month? First of all, your earnings change from month to month when you're a freelancer, they can, and your deductions can vary widely. It's really, really complicated. I don't know.
Have any of you actually tried to do it? I have figured out a way to do it based on taxes. What they should do is just look at your adjusted gross income for the previous year and just base it off that, give it to you for a year, and then next year just look at your adjusted gross income and base it on that because it is so difficult.
Brian Lehrer: I should say, Director Bassiri, that we have a couple of callers who are saying, "Hey, I'm a freelancer, and this is so hard to stay on top of with the paperwork requirements." What do you say to them?
Amir Bassiri: Well, I say to them that it's really dependent on the types of services that you need and your age. There are instances where individuals need institutional-type services, long-term services, and support that is done through a different process than the New York State of Health. It's done at the local districts. It is cumbersome. We have plans to reform that process. Unfortunately, they are not in place currently.
They are massive systematic changes, but with respect to anyone who is under the age of 65 and on the New York State of Health, I would say that the process is as seamless, if not more seamless than any other state Medicaid program and that we have a lot of tools and resources that we've made investments in, including our call center, our in-person assistors, the outreach. We have people to help.
I encourage anyone who is struggling to call the New York State of Health, and I'm happy to read out the number in the event that they need it. It's 1-855-355-5777, and there will be someone to assist you and walk you through the process. We have made changes to improve the member experience within the federal rules and we will continue to do that. We do have resources to help you through this process and assist you in various ways.
Brian Lehrer: As we run out of time, I gave that stat that half of the people in New York City are on Medicaid now, and I think Director Holahan, you said half the people in the state are on Medicaid or the related Obamacare marketplace programs. Why is that? People might find it either shocking that half of New York City is poor enough to qualify for Medicaid, or in some cases, they might think, well, government health insurance has expanded too much because half the city can't be poor enough that they need to be subsidized by the other half. The official poverty rate is less than 20%. Director Bassiri, in our last minute, can you help us make sense of why that number is what it is?
Amir Bassiri: Well, I think the number is what it is due to our suite of public health insurance products that we have. We have Medicaid as we've been talking about, most people are enrolled in Medicaid, but we do have Child Health Plus and the Essential Plan. Those programs have different eligibility requirements. They go up higher than the Medicaid levels, meaning it is not just half the population being on Medicaid but on some form of public health insurance.
The other reasons are that we have very generous benefits here in New York that we're very proud of and that we should all be proud of considering that we had 6 million people enrolled in Medicaid alone before this pandemic and now we're about 8. The question I would ask is what would happen if we didn't have the Medicaid program? The alternative is quite scary, to be honest with you.
There would be people without insurance. They would be showing up to receive health care at providers, they would not be able to pay those providers for services, or if they did, they would be spending out of their own income, and there would be worse outcomes for people because they likely would choose to avoid care given the cost. While it is a high number, we had a third of the population on it prior to the pandemic. We are now at half, as Danielle has said. I don't think it's uncommon as compared to California and other states like New York that have taken several actions to ensure people have access to benefits.
Brian Lehrer: We're getting so many calls from people who feel that they need help with applying or reapplying or staying on Medicaid. We could take calls with you till dinner time if we had the time, but I just want to at least be sure to give out the phone number again that you mentioned earlier, Director Bassiri, and tell me if I have it right because I'm going to say it on the air right now. It is 855-355-5777.
Amir Bassiri: That is correct.
Brian Lehrer: Who should call that number?
Amir Bassiri: Anyone who has questions about their Medicaid eligibility or needs assistance with any aspect of the process. We have over 2,000 customer service representatives that are willing and able to take your call. We have very good call response times and they would be happy to assist you.
Brian Lehrer: Again, that's 855-355-5777, 855-355-5777. We are very grateful to Amir Bassiri, New York State's Medicaid director, and Danielle Holahan, executive director of the New York State of Health, which is the individual health insurance marketplace that's part of the Affordable Care Act or Obamacare in New York State. Thank you so much for coming on. We really appreciate it.
Danielle Holahan: Thank you.
Amir Bassiri: Thank you for having us.
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