Medicaid disenrollment could drive many to ERs for health care, homeless expert says

This spring the Oklahoma Health Care Authority — the agency in charge of Medicaid in Oklahoma ― began to remove more than 250,000 people who were temporarily added to the Medicaid rolls during the COVID-19 pandemic.

And while the state's effort to comply with federal law will affect thousands, one group could get lost in the shuffle — the homeless. Homeless Oklahomans who lose their Medicaid, advocates say, have little recourse and few alternatives.

After the federal emergency designation ended on March 31, the Center for Medicaid and Medicare Services directed states to start trimming Medicaid rolls. In Oklahoma, state officials began disenrolling those residents who were designated as ineligible in April. The process did not go smoothly.

Two months later, the Oklahoma Health Care Authority temporarily stopped the disenrollment when officials discovered thousands who remained eligible were being removed from Medicaid due to the lack of proper paperwork. The problem wasn’t unique. Across the country, thousands of people removed from the Medicaid roles shouldn’t have been because they were still eligible — the issue centered on paperwork.

The Center for Medicaid and Medicare Services, responding to the glitch, wrote state officials in August, saying that many states had operational issues that may have caused many eligible residents to be improperly disenrolled — including thousands of homeless Oklahomans.

“When they expanded eligibility during the pandemic, it meant a significant number of people experiencing homelessness were eligible,” said Dan Straughan, executive director of the Homeless Alliance in Oklahoma City.

For thousands of homeless, Medicaid became an off again/on again concern.

Since then, the disenrollment has continued, leaving thousands — including those without housing ― without health insurance. It’s also put a strain on those health care providers that serve the homeless community: groups such as OU Health, Variety Health Care and Community Health Charities Inc.

Up to a quarter of Oklahoma's population may not have access to health insurance

Jeanean Yanish Jones, the executive director of the Oklahoma Health Alliance for the Uninsured, said earlier this year that unwinding the state's Medicaid rolls add to an already significant problem of uninsured people in Oklahoma.

Jones told the media outlet NonDoc the state has about 535,000 uninsured people, not even talking about the ones that are unwinding. "We have an additional almost 100,000 people that are undocumented that are also uninsured," she said. "Then you add in 308,000 unwinding, you’re getting close to a million people that don’t have [health insurance], which is about a quarter of our state’s population. So, this really is a crisis.”

The pullback on the number of those enrolled in Medicaid now means both OU and the nonprofits won't be paid for their services to the uninsured homeless.

Yet, the facilities continue to provide those same services.

More: A shortage of nurses has Oklahoma struggling to conduct regular inspections of nursing homes

“The financial impact of disenrollment is hitting those agencies in a more noticeable way than the people,” Straughan said. “At the same time, people are still able to access those services.”

But that safety net is getting thin and there are few alternatives.

Earlier this year, the Oklahoma Health Care Authority estimated that it would eventually disenroll about 300,000 Oklahoma adults and children from SoonerCare while the Oklahoma Human Services staff “will be required to disenroll the ineligible aged, blind and disabled population over a 12-month process.”

Nationwide, health care centers such as Variety Care and Community Health Charities Inc. have served more than 30 million patients in 2021, a study from Geiger Gibson Program at the Milken Institute School of Public Health said.

In Oklahoma City alone, Straughan estimated that between a third and one-half of the homeless population, about 1,436 people, will lose their Medicaid insurance.

Disenrollment expected to have 'significant ramifications'

"The changes are coming as health centers are reeling from the pandemic, a shortage of health-care workers and high rates of medical inflation,” the National Association of Community Health Centers reported.

Because nearly half of those who were served were insured by Medicaid, the program said, “disenrollment is expected to have significant ramifications for community health services.”

Emily Long, a spokesman for the Oklahoma Health Care Authority, said the agency was sensitive to the issue of disenrollment for the homeless. She said many homeless could have their cases reviewed under the ex parte renewal process, which allows the agency to renew benefits using pre-existing information and verify the data. "As long as the information is correct, members do not need to respond to the renewal notice and their coverage will continue," she said.

State officials say they are taking a cautious approach to trimming the rolls. “OHCA staff will review the circumstances for these members to determine if a member is a higher or lower risk as determined by critical health conditions, financial need and benefit utilization,” Secretary of Health and Mental Health Kevin Corbett said earlier this year in a media statement.

More: Lawsuit over Oklahoma's health information exchange going to trial in February

Ellen Buettner, the Oklahoma Health Care Authority chief, said her agency understood the problem and was working to be both transparent and understanding. She said her goal was better health outcomes for all Oklahomans.

“Our SoonerCare members have to be at the forefront of our mind,” she said.

Senate Pro Tempore Greg Treat said the Oklahoma Health Care Authority had funds set aside for the process. He said authority officials have done a good job in keeping lawmakers in the loop throughout the disenrollment process. "They did a very good job in communicating," he said.

State Medicaid Director Traylor Rains told Oklahoma Watch that many of the people in the early months were over the income limits and had not used any medical services during the pandemic. Oklahoma’s unwinding pause was self-directed and not mandated by the Centers for Medicare and Medicaid Services.

“We expected that group of folks to not really watch their mail or update their account because they probably went out and got or had third-party liability commercial coverage,” Rains told the outlet. “So the high rate didn’t alarm us as much as it alarmed CMS. We know as we go along, we’re seeing that rate go down because now we’re getting to the population that has used it, does rely on it and has kids under the age of 5.”

Still, for Straughan and others who serve the homeless community, the concern is that the health care safety net for the homeless is now shifting away from community health centers to a more expensive option.

“The safety net will become the emergency room,” he said. “The ER physician becomes your primary care doctor. People will put off primary care until it drives them to the emergency room and it’s going to increase costs for the whole system.”

This article originally appeared on Oklahoman: Many Oklahomans will seek ER care because they lack health coverage