Greetings on this fine Tuesday. My name is Rachana Pradhan, and I work as a correspondent for KFF Health News in the capital of our great nation. If you have any valuable tips to share (and I do mean the absolute best), please send them to rachanap@kff.org. If you haven't subscribed yet, you can do so by signing up here.
Now, let's dive into today's edition. The Biden campaign is actively seeking to capitalize on Donald Trump's criticisms of Obamacare. Additionally, a duo of Senate Democrats has accused one of the leading anesthesiology firms in the country of participating in anticompetitive practices. However, before we delve into those stories, let's cover some other important news.
States sometimes fail to thoroughly review the complete checklist before removing individuals from Medicaid, disregarding the process of "unwinding" the program.
Earlier this year, Beverly Likens believed she had completed all the necessary steps to maintain her Medicaid coverage. However, she was met with an unpleasant surprise when the hospital informed her that her insurance was inactive just before her surgery to address chronic bleeding. This put her procedure at risk. Likens, who was 48 years old at the time and a resident of Kentucky, had recently been diagnosed with severe anemia and had received a blood transfusion at the emergency room. She described feeling on the verge of falling apart. She and a lawyer who tried to assist her both believe that the coverage gap she experienced should never have occurred.
This situation sheds light on a complication known as the Medicaid "unwinding." States are currently reviewing the eligibility of millions of Americans who remained enrolled in the safety-net health program throughout the pandemic. However, as reported by KFF Health News, the process has been chaotic and messy, causing problems across the country.
One of the reasons for this chaos is that individuals are being asked to reapply for Medicaid when they shouldn't have to, or they are being dropped from the program even though they still qualify. Consumer advocates and legal aid attorneys have pointed out that some states are not adhering to federal rules that require them to consider all possible ways in which individuals may qualify for Medicaid before determining their ineligibility and terminating their coverage. This is exactly what happened to Likens.
Prior to losing her coverage, Likens qualified for Medicaid due to her participation in the Supplemental Security Income program. This program is designed for individuals who have little to no income or assets and are either blind, disabled, or at least 65 years old. However, in the spring, Likens lost her SSI benefits because she possessed assets with a cash value that exceeded federal limits. In April, Kentucky's Medicaid agency sent her a notice stating that she would automatically lose her health coverage but could reapply.
The state did not assess whether Likens qualified for Medicaid through another avenue, even though she did. Despite no longer receiving SSI, her income was still low enough to meet the requirements. When she attempted to reapply herself, she encountered technical difficulties with Kentucky's enrollment system, which is a common issue across the country.
Undoubtedly, there are significant challenges and flaws within the Medicaid system that need to be addressed to ensure that individuals like Likens do not fall through the cracks and face unnecessary coverage gaps.
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