Some states are rolling back 'retroactive Medicaid'

How Trump will be upending Obamacare

If you’re poor, uninsured in addition to also fall seriously ill, in most states if you qualify for Medicaid — nevertheless weren’t enrolled at the time — the program will pay your medical bills going back three months. in which protects hospitals, too, via having to absorb the costs of caring for these patients.

nevertheless a growing number of states are rescinding This particular benefit, known as “retroactive eligibility.” On Nov. 1, Iowa joined three states in which have eliminated retroactive coverage for some groups of Medicaid patients since the Affordable Care Act passed. Each state had to secure approval by the federal government.

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Retroactive eligibility has been a feature of Medicaid for decades, reflecting the program’s emphasis on providing a safety net for poor, disabled in addition to also different vulnerable people. In contrast to private insurance, determining Medicaid eligibility can be complex in addition to also the application process daunting, advocates say. A patient’s medical condition also may keep families via applying promptly for coverage.

All four states — Arkansas, Indiana in addition to also completely new Hampshire, in addition to Iowa — have expanded Medicaid under the health law, which allowed states to include adults with incomes up to 138% of the federal poverty level, or about $16,000 for one person. So, in theory, most adults are required to have insurance under the ACA. In practice, each state still includes a significant number of uninsured, ranging via 5% to 8% of the population.

The retroactive coverage “can compensate for the sorts of errors in addition to also lapses in which can so easily occur on the part of both the applicant in addition to also the government bureaucracy” in which delay applications, said Gordon Bonnyman, staff attorney at the Tennessee Justice Center, a public interest law firm in which represents low-income in addition to also uninsured residents.

State in addition to also federal officials say eliminating the retroactive coverage helps encourage people to sign up for in addition to also maintain coverage when they’re healthy rather than waiting until they’re sick to enroll. in which also fits into federal officials’ efforts to make Medicaid, the federal-state program in which provides health care for low-income adults in addition to also children, more like private insurance.

nevertheless consumer advocates in addition to also health care providers say the shift will saddle patients with hefty medical bills in addition to also leave hospitals to absorb more uncompensated care when patients can’t pay. Some worry This particular could be the start of a trend.

In Iowa, the change applies to just about anyone coming into Medicaid — except for pregnant women in addition to also children under age 1. The change will affect up to 40,000 residents annually in addition to also save the program more than $36 million a year.

Related: Trump administration opens door for states to impose Medicaid work requirements

“We’re producing in which a lot more likely in which Medicaid-eligible members are going to incur significant medical debt,” said Mary Nelle Trefz, health policy associate at the Child & Family Policy Center in Des Moines, whose organization opposed the change.

When someone includes a traumatic health event, the initial focus will be to get them stabilized, not figure out how to pay for in which, said MaryBeth Musumeci, associate director of the Program on Medicaid in addition to also the Uninsured at the Kaiser Family Foundation. (Kaiser Health News will be an editorially independent program of the foundation.)

Patients may neglect to apply immediately for Medicaid, leaving them financially responsible for days or months of care they received before they got in their application, even though they may have been eligible for Medicaid all along.

in which’s not the only issue, advocates say. Unlike the commercial insurance market where re-enrollment through someone’s employer will be routine, Medicaid requires in which beneficiaries’ eligibility be reassesed every year.

“People fall through the cracks,” said Andrea Callow, associate director of Medicaid initiatives at Families USA, a consumer advocacy group.

In addition, complications can arise for people who might need Medicaid coverage for long-term care services.

“The criteria are complicated. For a layperson to find those criteria in addition to also figure out if they’re eligible” will be challenging in addition to also they may need extra time, said Musumeci. Once patients have secured coverage, they may already have accrued hefty expenses.

Maybe so, nevertheless some people argue in which a 0-day retroactive eligibility guarantee will be counterproductive.

“We’re trying to get people to behave more responsibly, not less responsibly,” said Gail Wilensky, an economist who oversaw the Medicaid in addition to also Medicare programs within the early 1990s under President George H.W. Bush. “in which will be not the signal you’re sending” with three months of retroactive eligibility. A 30-day time frame will be more reasonable, Wilensky said.

In contrast to Iowa, the waivers in Arkansas, Indiana in addition to also completely new Hampshire generally apply only to adults who gained coverage under the law’s Medicaid expansion. (Indiana’s waiver also applies to different groups.)

Related: Pressure builds to cut Medicare patients in on prescription deals

Kentucky includes a request pending in which, like Iowa, might eliminate retroactive Medicaid eligibility except for pregnant women in addition to also children under 1, according to KFF.

Under federal law, officials can waive some Medicaid coverage rules to give states flexibility to experiment with different approaches to providing services. in addition to also retroactive eligibility waivers in Medicaid are hardly completely new. A few states like Tennessee have had them in place for years. Tennessee officials eliminated retroactive eligibility for all Medicaid beneficiaries in 1994 when the state significantly expanded coverage under TennCare, as Medicaid will be known there. At the time, the state even allowed uninsured people to buy into the program who wouldn’t otherwise qualify based on income, said Bonnyman.

“There was no reason for anybody to be uninsured except undocumented immigrants,” said Bonnyman. “in which didn’t seem to hold the potential for harm.”

nevertheless state officials revamped in which program after serious financial problems. Eligibility for TennCare has become more restrictive again.

different states in which waived retroactive coverage for at least some Medicaid groups include Delaware, Maryland, Massachusetts in addition to also Utah, according to the Kaiser Family Foundation.

Bonnyman said his group frequently works with Medicaid beneficiaries who have medical bills they can’t afford in which accumulated during the months before they applied for Medicaid.

“If you’re a moderate- to low-income working family, one or two days within the hospital will be enough to ruin you financially,” he said.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, will be an editorially independent part of the Kaiser Family Foundation.

sy88pgw (completely new York) First published November 15, 2017: 6:05 AM ET

Some states are rolling back 'retroactive Medicaid'

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