Removal of people from Medicaid rolls, mostly because they don't follow procedure, starts to hurt rural health care

Looking for help at an office in Arkansas, which has aggressively
cut Medicaid rolls. (Photo by Andrea Morales for The Washington Post)

About 4 million Americans have been taken off the Medicaid rolls this year, most of them for reasons unrelated to their eligiblity, according to the Kaiser Family Foundation, a health-policy organization.

"Three-fourths have been removed because of bureaucratic factors," reports Amy Goldstein of The Washington Post. "Such 'procedural' cutoffs — prompted by renewal notices not arriving at the right addresses, beneficiaries not understanding the notices, or an assortment of state agencies’ mistakes and logjams — were a peril against which federal health officials had cautioned for many months."

When the pandemic began, the governments suspended the annual renewal process, in which Medicaid beneficiaries certify their eligibility. Now that process has resumed, and federal officials are finding problems with how states are handlign it. Nine states have agreed to pause removals from the rolls, but the removals are beginning to undercut health care in rural areas, which are more dependent on federal health programs.

"The large proportion of beneficiaries in some states tumbling into the ranks of the uninsured is starting to hurt clinics and hospitals that focus on low-income patients — especially in the poorest states, such as West Virginia, where about 1 in 3 residents have relied on Medicaid," Goldstein reports. At the clinics of Cabin Creek Health Systems, patients arrive every day only to find that they are not covered, Executive Director Craig Robinson told Goldstein: “It’s a total failure, this unwinding.”

Goldstein reports, "At West Virginia Health Right, a Charleston clinic with 43,000 patients at three sites, the number covered by Medicaid fell by about 1,600 in May and June, the first two months of that state’s unwinding, according to Angie Settle, the clinics’ chief executive. The number of uninsured patients, usually fairly stable, rose by about the same number during those two months. Settle said the unwinding is putting a strain on the staff as new people show up for medical services they can no longer afford — and a strain on finances as more people show up for medications for which no one else is paying the costs."

The Centers for Medicare and Medicaid Services says 34 states "have been out of compliance with at least one federal requirement," Goldstein notes, "but even some states that meet all the federal rules have high rates of people being dropped from the program for paperwork reasons, mystifying state officials and patient advocates alike."