MINNEAPOLIS — Beginning Saturday, states across the country will be able to wean large numbers of people off Medicaid who were allowed to remain in the program during the COVID-19 pandemic. That includes about 1.5 million Minnesotans in low-income health programs, many of whom are soon at risk of losing needed coverage.
At-risk individuals who are still eligible can remain on the Medicaid lists without seeing a coverage gap, but only if they complete the renewal process by the state’s rolling deadlines.
Concerned about the potential devastating impact of hundreds of thousands of Minnesotans losing their health insurance, officials are now working to restore care to those affected. But it’s a daunting task that could complicate the state system.
“We estimate that between 15 and 30 percent lose access or are unable to renew,” said Dr. Nathan Chomilo, director of Medicaid in the Minnesota Department of Human Services. “Of those, 25 to 50 percent will likely be able to renew within the next six months, suggesting they likely would have retained their eligibility had they gone through the process.”
Medicaid is a state-administered health insurance program based on federal requirements that supports people on low incomes. Eligibility is based on income and assets. After participating in the program, recipients go through a periodic reassessment process that assesses their income to ensure they remain within coverage limits.
For three years, this renewal process was interrupted when the COVID-19 pandemic swept the country. To keep people from losing their health insurance when they need it most, the federal government has increased funding for states that have instituted continuous Medicaid coverage. Since then, states have generally not kicked people out of the program unless they asked to be removed.
States have about a year to complete re-enrollment, with each approaching the process differently. Minnesota evaluates people who participate in two different programs: Medical Assistance — the state’s name for its Medicaid program — and MinnesotaCare, a state-specific program for people who earn too much to qualify for Medicaid.
For Medical Assistance, renewals are processed on an ongoing basis, with individuals divided into different cohorts based on the date they originally enrolled for coverage.
While this makes it easier for officials to process the paperwork, it poses its own challenges for those affected. “Maybe you’ll hear about it and think you’re ready. But then you have to wait until the actual month of your renewal. And so it adds another layer,” Chomilo said.
This process can be complicated, a reality well known to people working in local clinics.
Geraldine Cereceda recalls her first encounter with the complex US healthcare system after her son fell ill shortly after immigrating with her family from Peru to Minnesota.
“I had no idea where to start, the system was terrible. [It was] difficult for me to understand,” she recalled.
Cereceda went to Southside Community Health Services, a state-approved health center in south Minneapolis, and got the help she needed. For the past 22 years, she has returned that help as a patient advocate and now as the clinic’s Community Engagement Manager. She and her small team help educate people about their options and enroll in coverage through MNsure, the state’s health insurance marketplace.
The team is busy and doesn’t expect things to slow down anytime soon as the majority of the patients they see are preparing to go through the Medicaid renewal process.
However, Minnesota is one of the few states where coverage cannot be renewed online. Renewal can only be completed through the paper forms that are mailed to recipients.
While some insurance navigators said an online system wouldn’t necessarily fix everything, Southside Clinic’s Cereceda said the option would make a difference.
“Everyone has access to their phone even if they don’t have a computer,” she said. “Why isn’t that possible? Everyone knows how to manage their phone.”
“If we don’t have the tools, it will be difficult”
State officials said infrastructure for an online system has been in the works since February 2022. But with Medicaid reassessments coming up, DHS officials didn’t want to rush rollout and said they were working to support claimants in other ways.
“We are also working with many partners and community organizations to ensure enrollers are supported through community outreach, assistance in completing their renewals including completing forms over the phone, improved staffing and follow-up if someone fails to return their form will be,” officials said in a statement.
Because the renewal process relies so much on the Post Office, there is increasing pressure on recipients and the insurance navigators who help them to ensure that the county and tribal offices that work with the state to administer the program have the correct information in the have files. And that important paperwork doesn’t end up in the wrong place.
That’s no small problem. Analysis by the nonprofit Kaiser Family Foundation found that people who have moved since the pandemic began, people with limited English skills, and people with disabilities are at the highest risk of losing Medicaid coverage during the process. National estimates say 15 million people could be dropped during this process, and almost half of those (6.8 million) would lose insurance coverage despite still being eligible.
For Marlon Hernandez, an MNsure navigator at Neighborhood Health Source in northeast Minneapolis, that means spending a lot of time on the phone with patients and county officials updating addresses. Some are easier than others.
“For example, when Anna comes to see me [and] she lives in anoka county, we can definitely talk on the phone. It may be 20 minutes before we reach someone and tell them Anna’s address has changed,” he said. Others, like Hennepin County, respond almost immediately, he said, and have the address changed quickly.
While changing an address is only a small part of the process, and the system is set up to allow recipients to perform this and other processes themselves, patients may find it easier to have a navigator with them. Some patients may have language or educational barriers, or may be overwhelmed with the process itself.
“Most of the communities we serve live in poverty. So poverty in itself is a major barrier,” said Stella Whitney-West, CEO of Northpoint Health & Wellness Center in north Minneapolis. “So when people try to deal with housing and just basic needs, it adds another level of complexity to their lives. I find it amazing how we stack the most on the people who have the least.”
But with hundreds of thousands of people at risk of losing insurance coverage, there aren’t enough navigators to help every single person who might need it. Like other healthcare professionals, navigators have experienced staff turnover and staff shortages since the pandemic.
To ease some of the burden on Medicaid recipients and navigators, the Minnesota Senate passed legislation Monday that would bring more flexibility to the Medicaid renewal process and more funding for MNsure navigators. The House of Representatives is expected to take up the bill this week.
Meanwhile, at the Southside Clinic, Navigators are trying to see as many patients as possible. Appointments are scheduled two months in advance, so they try to engage with more patients between meetings, or squeeze them in if someone cancels, but the team is stretched thin.
The already long wait has raised concerns about whether they can see all the patients they need before their Medicaid renewal records are due. While Cereceda said she is confident they will be able to guide people through the process, she worries about the burden on herself, her team and the organization.
As a state-qualified health center, the clinic doesn’t turn down the service and offers tiered fees that people can access if they have a coverage gap during the process, but said it worries about how they’re maintaining this for everyone could, she might need it now.
“I can see all the weight — stock weight is going to come our way, and we’re going to be struggling with monies,” she said. “We’re here to give consumers easy access to health, but if we don’t have the tools, it’s going to be difficult.”