People line up outside an assisted living office in Missoula, Montana, at 8 a.m. on Oct. 27, 2023. People trying to regain health insurance after being excluded from Medicaid, the government insurance program for people with low incomes and disabilities. .
Katherine Houghton/KFF Health News
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Katherine Houghton/KFF Health News
People line up outside an assisted living office in Missoula, Montana, at 8 a.m. on Oct. 27, 2023. People trying to regain health insurance after being excluded from Medicaid, the government insurance program for people with low incomes and disabilities. .
Katherine Houghton/KFF Health News
On a cold morning in February, guests at the Kochi Warming Center in Kalispell, Montana, were preparing for the day after spending the night at the shelter. But Tasha Evans stayed put. She needed help applying for Medicaid.
She said she lost her Medicaid coverage last September because she didn't receive her paperwork after moving from Great Falls, Montana.
Without insurance coverage, she was forced to discontinue her blood pressure treatment and suspend urgently needed dental care.
“My tooth was broken. My gums hurt. Sometimes I feel sick and don't want to eat,” she said.
Tasha Evans waits outside the Flathead Warming Center, a low-barrier shelter in Kalispell, Montana. March 5, 2024. Mr. Evans had just finished work for her that night in time to join the line for her bed.
Aaron Bolton/Montana Public Radio
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Aaron Bolton/Montana Public Radio
Tasha Evans waits outside the Flathead Warming Center, a low-barrier shelter in Kalispell, Montana. March 5, 2024. Mr. Evans had just finished work for her that night in time to join the line for her bed.
Aaron Bolton/Montana Public Radio
Evans is among the roughly 130,000 people who have lost Medicaid coverage as states reassess everyone's eligibility following a federally mandated moratorium on disenrollment that began during the coronavirus pandemic. He is one of the Montanans.
After the federal government lifted the public health emergency, states had to resume regular eligibility testing and faced large backlogs. After a historic surge in Medicaid enrollment during the pandemic, more than 10 million people will no longer be eligible for coverage due to the difficult bureaucratic process of state-by-state eligibility checks known as “Medicaid redetermination.” Ta.
About two-thirds of people removed from Montana's Medicaid rolls lost their rolls for technical reasons, such as filling out paperwork. This is one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.
Even unsheltered people like Evans are losing coverage, even though state officials say they will use Social Security and disability data to automatically renew those who should remain eligible. It's coming.
Medicaid recovery is difficult for people without housing
As other guests left the shelter on a February morning, Evans sat in an empty office as an application counselor at the Greater Valley Health Clinic, which serves much of the homeless population here. He sat down and talked about the hardships he had to go through to re-register.
Evans told the counselor that she had sought help from the state Department of Human Services. However, the staff did not have time to answer her questions about what forms she needed to fill out or go through the paperwork with her. She called the state's helpline, but she couldn't get through.
“You get to a point where you're like, 'I'm frustrated right now, I just have other more important things to do, so let's not deal with it,'” she says.
Evans has a job but no housing, so he spends most of his free time looking for a place to sleep. It's not practical to sit down and talk on the phone most of the day.
Kochi Warming Center is a low-barrier shelter located in Kalispell, Montana. The shelter has 50 beds for overnight stays, but often has to turn residents away when it's full.
Aaron Bolton/Montana Public Radio
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Aaron Bolton/Montana Public Radio
The Kochi Warming Center is a low-barrier shelter located in Kalispell, Montana. The shelter has 50 beds for overnight stays, but often has to turn residents away when it's full.
Aaron Bolton/Montana Public Radio
There is no public data on how many unhoused people have lost Medicaid in Montana or nationwide, but homeless service providers and experts say it's a big problem.
Those who help unsheltered people who have lost Medicaid coverage say they spend much of their time helping people contact Medicaid offices in Montana. Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman, said sorting out mistakes on paperwork can also be a headache.
“You're getting emails like, 'Oh, this needs to be submitted by this date,' and it's already been two weeks. So now you have to start the process all over again.” said Assistant Secretary Baker. “Right now, I have to wait two to three months without insurance.”
Montana health officials told NPR and KFF Health News in a statement that they have provided training to agencies serving unhoused clients to prepare them to go through the redetermination process. said.
Warning text and call to stop
Federal health officials have warned Montana and some other states against pulling large numbers of people from Medicaid rolls due to technicalities such as paperwork issues. The agency also warned states of unreasonable barriers to accessing help, including long waits on helplines. The Centers for Medicare and Medicaid Services has told states they may be able to order a halt to the procedure, but so far has not issued an order.
In Montana, Democratic lawmakers asked the state health department to pause the redetermination process, but the agency's director, Charlie Brereton, resisted. The redetermination ended in January, four months ahead of the federal deadline.
“I have confidence in the redetermination process,” Brereton said. “I believe that many of the Medicaid members who were disenrolled were disenrolled correctly.”
Health care industry observers say homeless people are being excluded from Medicaid rolls in both liberal-leaning and conservative-leaning states, and the redetermination process is chaotic everywhere. Unprotected populations are particularly vulnerable and unable to cope with bureaucratic barriers, making them especially easy to slip through the cracks and lose coverage.
Why spotty insurance coverage affects your health
Dr. Margot Kuschel, a physician and homeless researcher at the University of California, San Francisco, says filling out the forms may not seem like a big deal. However, homeless people lead unpredictable and precarious lives. “Put yourself in the shoes of an older adult experiencing homelessness,” Kuchel explains. This is especially true for people who don't have access to computers, phones, or cars.
If still eligible, people are usually able to eventually renew their Medicaid coverage and receive retroactive reimbursement for medical expenses they received while unenrolled.
But Kuchel said being without health insurance for extended periods of time can be dangerous, especially for homeless patients, who have higher rates of chronic illness.
“Not being able to take your asthma medication for three days can put your life at risk. If you have high blood pressure and suddenly stop taking your medication, your blood pressure will skyrocket and your risk of having a heart attack will increase significantly. ” Kuchel said. ”
When people don't understand why they lost their insurance or how to get it back, Kuchel says, trust in the health care system erodes.
Evans, a homeless woman from Kalispell, received help with her application and has a good chance of getting coverage again.
Re-enrollment of eligible patients could take several years
Social services agencies in Montana predict it will take years to get everyone who recently lost insurance back on Medicaid. They worry that people who travel without insurance will end up in the emergency room rather than actively managing their health conditions.
Crystal Baker, a case manager at a homeless shelter in Bozeman, Montana, recalled her efforts to help another client re-enroll in Medicaid after losing coverage due to a technical error. She set up several phone calls with state officials so he could conduct an interview to see if he was still eligible. But the state never called back.
“He waited all day. By the fifth time, it became so stressful for him that he gave up right away,” she says.
That client eventually left the Bozeman area before Baker could persuade him to continue returning to Medicaid.
Now, Baker worries that her health problems will catch up with her first.
This article was produced as part of the NPR Health Reporting Partnership. MTPR and KFF Health News.
