Fred L. Goldenberg: Medicaid loss

Aug. 13—Medicaid is a health insurance program that provides coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by the states and the federal government.

The Michigan Department of Health and Human Services (MDHHS) reports that as of April 2023, Michigan has enrolled 3,085,022 individuals in Medicaid and CHIP — an increase of more than 60% since the passage of the Affordable Care Act in 2013.

The ACA has provisions allowing for increased funding if states approved the expansion of Medicaid. To date 39 states, including Michigan, agreed to the ACA expansion provisions, which has had an impact on Medicaid enrollment and eligibility.

With the outbreak of COVID-19 and the subsequent "lock down," those in need increase exponentially. With the passage of the Families First Coronavirus Response Act in 2020, Michigan agreed to pause redetermination and not remove anyone enrolled or enrolling in Medicaid in return for a major increase in federal funding. More than 700,000 people were able to enroll in Medicaid without the required paperwork during that period. With the end of the public health emergency, the additional funding has ended.

In my April column, I wrote that with the end of the public health emergency, all of Michigan's Medicaid beneficiaries must file for redetermination. That day of reckoning has arrived. At this moment, more than 100,000 people are on the verge of losing their coverage because they didn't fill out the required paperwork, which was due at the end of July.

According to MDHHS, from this first batch of approximately 300,000 redeterminations, the state has renewed Medicaid or Healthy Michigan coverage for 103,540 people. But of those, only 30,456 submitted paperwork and 73,084 were "passively" renewed because MDHHS was able to confirm eligibility through other client services organizations.

That means that MDHHS still had over 100,000 people who have not returned their paperwork and could lose their coverage on Aug. 1. Since the state is staggering the renewal process, the number of those losing coverage could be limited as people receive multiple notifications.

Recently I had a new client come in who will be turning 65 in a few months. He informed me that he would be dual eligible (Medicare/Medicaid) and could qualify for a special needs policy. He had enrolled in Medicaid during the 2020 COVID-19 pandemic when no paperwork was required, and the annual redetermination process was put on hold.

He said that he "kind of remembered" getting something from MDHHS, but he didn't really pay attention. Since his enrollment date isn't until September, he will maintain coverage but will need to fill out paperwork to determine if he qualifies for the special needs plan. I suspect once he includes his income and assets the answer is no.

He won't be alone. In this first batch of redeterminations almost 7,000 people, who returned their paperwork, were no longer eligible because their income has gone above the threshold, or their cases were closed because they didn't return the paperwork updating income.

In a recent press release, Meghan Groen, MDHHS senior deputy director, said "While we're happy that many Michigander's have maintained coverage, we want to emphasize how important it is for people who receive reenrollment packets to fill out their information and return it promptly."

Although MDHHS will continue to reach out, if you fail to return the forms, there could be dire consequences going forward.

For those under age 65 who fill out the paperwork and lose eligibility, you will receive a special enrollment period that allows you to go the ACA Marketplace and get health insurance. But for those who don't, it's a different story. If you fail to return the form, you lose the SEP option and will have to wait until open enrollment.

If you are over 65 and on Medicare, you have an easier time. Medicare allows for such an occurrence and all you need to do is call my office and we can provide information and coverage.

In either case, it's imperative that you fill out and return the reenrollment forms as soon as you get them. Coverage is available in either scenario, so do your part.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a financial services and certified health insurance organization affiliated with Michigan Planners in Traverse City. If there are questions or comments about this column or interest in monthly Medicare classes, call 231-922-1010 or email fred@srbenefitsolutions.com.