July 5, 2023

With end of public health emergency, thousands in danger of Medicaid disenrollment without action

Individuals receiving a large, turquoise envelope through the mail should open it because it could be from the New Mexico Human Services Department informing the family they are losing Medicaid coverage.

With the end of the federal public health emergency in May, individuals who have not recertified or shown documentation to prove eligibility over the last three years will lose Medicaid coverage.

Lorelei Kellogg, New Mexico Human Services Department Medicaid director, told NM Political Report that the federal public health emergency came with “pretty strict mandates about disenrolling people,” from Medicaid if they have not recertified or have not provided documentation proving eligibility.

Theresa Noedel, Holy Cross Medical Center benefit navigation coordinator in Taos, said many people don’t realize they’ve lost their Medicaid coverage until they are at a hospital or a doctor’s office and the medical staff tell the patient they do not have insurance. Noedel said that when patients learn they’ve lost their Medicaid coverage through a doctor’s office or hospital, they are often “freaking out.”

“Especially if they don’t have the money to pay for care or medication,” Noedel said.

Kellogg said that during the public health emergency, individuals who didn’t recertify or never fully submitted eligibility information were kept on Medicaid.

“We didn’t terminate anybody for procedural or administrative reasons during COVID,” Kellogg said.

Kellogg said she didn’t know the exact number of people who will be disenrolled. But Noedel said the state is backlogged by the process and it is slow.

“I’m not as busy as I thought I would be,” Noedel said.

She said she expects to be busy in August because the Medicaid office is in the process of sending out the turquoise envelopes now.

“It’s taking up to 90 days to recertify or process a new application. If they [the Medicaid recipient] don’t meet with someone like me, they’re screwed,” Noedel said. “Nobody should be without insurance. What if they have cancer or heart issues?”

If a person has lost coverage because they didn’t recertify, a benefit navigation coordinator like Noedel can enable the patient to gain presumptive eligibility. Noedel said it starts the day she meets with the patient and will run a month but the presumptive eligibility can be extended an additional 30 days if HSD doesn’t process the application within the first 30 days.

Noedel said every hospital in New Mexico has someone like her who can help patients navigate applying to Medicaid, though sometimes the person is called a financial counselor. She said she helps individuals who call from all over the state, even though she is based in Taos.

“Nobody should have to stress out over insurance,” Noedel said.

Divya Shiv, research and policy analyst for New Mexico Voices for Children, called the disenrollment “really scary.”

She said that during the pandemic, when families were able to stay on Medicaid regardless of whether they recertified or provided documentation proving eligibility, many families experienced economic stability and were protected from the high cost of medical care.

If children go without insurance coverage because a family does not recertify, if the turquoise envelope gets lost in the mail or the family doesn’t open it right away, or if the family can’t find the documentation necessary to recertify, there are potentially “really terrifying damages” to the child’s physical and mental health, Shiv said.

“We see uninterrupted care as really essential for success in school and as the foundation for health and well being through the rest of their lives,” Shiv said.

One potential unintended consequence of the disenrollment is that, given the severe medical provider shortage in New Mexico, a gap in health insurance could lead a family to have to start over with finding a new provider and not all take new patients.

Noedel said she tried to find a specialist for her granddaughter and was told the specialist has a two-year waiting list.

“Most are not taking new patients. Now it’s a year wait at some clinics, not just here but all over New Mexico,” Noedel said.

Shiv called it “an extra burden” to find a new physician after going through the process of disenrollment.

Last year the state implemented new rule making after a federal provision allowed states to extend Medicaid postpartum care to 12 months, an extension of 10 months to the previous set of rules. 

Related: State expands postpartum Medicaid coverage to 12 months

Kellogg said the extended Medicaid postpartum care of 12 months of coverage didn’t really impact families last year because the state allowed individuals to remain on Medicaid through the pandemic even if they did not recertify. But now, that 12 month of extended coverage will really help offset the disenrollment process, Kellogg said.

“We haven’t seen a direct impact yet because everybody’s Medicaid got extended the whole time [of the pandemic]. But with the unwinding of the public emergency, it’ll make a difference for folks. It has yet to really show us a whole lot because it hasn’t been given the opportunity to shine because everybody was covered. During COVID, it didn’t matter how far out you were [in not recertifying], you retained coverage,” Kellogg said.

Extending Medicaid coverage for new mothers to 12 months from the previous time limit of two months is expected to help with maternal mortality. With 21.5 deaths per 100,000 live births, New Mexico rates higher for maternal mortality when compared to the national average of 17.4 deaths per 100,000 live births nationally. Maternal mortality impacts women of color at higher rates than white women. 

Shiv said pregnant individuals or families with children “need more service.”

“Having coverage to access healthcare when they need it is really critical, especially with healthcare deserts,” she said.

Substance abuse disorders play a role in maternal mortality. According to the New Mexico Maternal Mortality Review Committee, nearly half – 49 percent—of all maternal deaths from 2015 to 2019 involved substance abuse disorders. Of those, 79 percent occurred somewhere between 45 days and 365 days after birth and 75 percent were preventable.

Jodi McGinnis-Porter, spokesperson for New Mexico Department of Health, said this is the latest data available for the state.

The expanded 12-months of Medicaid coverage for new mothers is expected to cover 17,000 individuals, according to HSD. Pregnancy-associated deaths are 4.6 times greater in New Mexico for Medicaid recipients than for women with private health insurance. The majority of births, nearly 80 percent, in New Mexico are covered by Medicaid, Kellogg said.

Kellogg said HSD didn’t know when the end date for the public emergency would come, but in late 2021 when the state began the process of rulemaking to extend the Medicaid coverage to 12 months, HSD was “aware it would eventually go away.”

“We wanted it [the extension of 12 months of coverage] in place to be allowed to provide coverage to folks,” she said.