Thousands of Michiganders could lose Medicaid coverage if they miss the mail

• Under a pandemic rule, Michigan couldn’t bounce anyone from the state’s Medicaid program.
• That swelled Michigan’s Medicaid to unprecedented size — more than 3 million people in all. 
• Now, the state is paring back. Thousands could lose coverage without noticing until their next doctors’ appointment or prescription refill.

Hundreds of thousands of Michigan residents could lose their Medicaid coverage if they ignore their mail.

The Michigan Department of Health and Human Services this week dropped into the mail a second batch of letters — this time to 154,315 Michiganders — alerting them that they soon could lose Medicaid health care coverage.

It’s the second time in as many months of letters as the clock winds down on a special COVID-era rule that allows people to stay on Medicaid without proof they’re eligible.

Related:

• Michigan’s Medicaid ballooned during COVID. It’s about to be pared back
• Medicaid review could drop 400,000 Michigan residents from coverage

That rule, in turn, has allowed Michigan’s Medicaid, including the MI Child and Healthy Michigan Plan, to balloon in Michigan to more than 3 million beneficiaries — the largest it has ever been.

Now the state is paring back.

And with that comes the worry.

“It’s that people will get caught up in a bureaucratic churn,” said Tina Golding-Jewett, a senior manager overseeing outreach at Honor Community Health, which provides primary, dental, behavioral and sexual health care to patients at 20 health centers in Oakland County.

There, 90,000 of the county’s residents are covered by Medicaid, including 15,000 people who enrolled during the pandemic, said Bill Mullan, county spokesman.

“And remember, some of the patients are children,” Golding-Jewett said.

Unprecedented growth

Since the pandemic began, nearly 700,000 additional Michigan residents have collected Medicaid benefits.

But some of those beneficiaries are no longer eligible for Medicaid because their income or family size has changed or a new employer now offers health coverage.

Those who lose coverage could face surprise bills the next time they go for a check-up, are rushed to the emergency room, or try to fill a prescription.

“And you have to wonder: If they are going to fill a prescription, how many will say ‘I have to make a call and re-enroll,’ and how many will just walk away leaving their medications behind?” said Anne Scott, health center operations officer at Michigan Primary Care Association, which represents Honor and more than 40 other health clinics that primarily serve un- and under-insured patients throughout Michigan.

That, in turn, can mean bigger costs for taxpayers, she said, as chronic conditions spiral out of control. Additionally, patients whose medical bills begin to pile up at one clinic may begin provider-hopping, which can lead to duplicated medical services — scans or tests at multiple doctors offices, she said.

On a rolling basis, over the next year, Medicaid beneficiaries will need to resubmit their proof of eligibility. They’ll face “redetermination” the same month that they enrolled in the program, said Farah Hanley, a chief deputy director for health at the Michigan Department of Health and Human Services. Hanley is overseeing the redetermination effort.

The health department sent out a first batch of letters in March — 133,746 in all. The warning letters are followed by an informational package tailored to beneficiaries, letting them know what steps they need to take or documents they need to provide to “recertify” for Medicaid.

Those whose letters were mailed in March, for example, will have until June 30 to re-enroll.

Some beneficiaries may be re-enrolled without having to take action if the state already has their information because they’re in other programs, such as food assistance, she said.

But how many will be passively enrolled isn’t clear. Hanley estimated that it will be less than half — likely much less.

The first beneficiaries will be disenrolled starting July 1.

Hanley said the state is reaching out to beneficiaries in multiple communications, including public service announcements on TV, in social media and even on video screens at gas pumps, letters in the mail from both the state and insurers, emails, texts and robo-calls.

At Honor, staff for weeks have been wearing bold blue-and-orange badges, inviting patients to “ask me about insurance.”

And all staff — from those who make appointments to the medical assistants who take blood pressure to clinicians to the chief executive officer — have been trained to ask patients who are covered by Medicaid if they know about the need to re-enroll and to funnel them to an Honor community health worker who can answer questions and can help them re-enroll.

Some beneficiaries will no longer be eligible for Medicaid because of income and other changes, but they also don’t have employee-sponsored coverage. Staff at Honor and other clinics can help them sort through commercial insurance options on the online, individual marketplace, www.healthcare.gov.

Whatever the patient’s reality, the first step is knowing that their coverage is no longer guaranteed, advocates told Bridge Michigan.

Patients generally see or talk with at least five people at Honor — from the time they make their appointment to the time they leave, Golding-Jewett said. For those on Medicaid, that means multiple opportunities to be reminded that their health coverage might be on the line. have their questions answered, and — if necessary — be connected with a community health worker that can help them go online and re-enroll.

A clinic’s conference room, in fact, was recently outfitted with computers for that reason, and Honor’s community health workers now work in there, meeting with patients throughout the day.

The way Golding-Jewett she sees it, “it usually takes about three times to hear something before you act.”

If all goes well, she said, the patient leaves the office having submitted their paperwork to ensure their coverage continues uninterrupted.

Wrong addresses

Michigan’s health care providers also have a stake in making sure people maintain coverage. Medicaid payments, though lower than reimbursements from commercial insurers or Medicare, are the lifeblood of many health clinics’ budgets.

Like the state, Honor quickly realized how difficult snail mail outreach will be.

It scraped its patient records for 18,960 addresses of people who had been on Medicaid at some point in the past three years, sending out warning postcards to those patients.

But about 1,200 were undeliverable. People had moved, or addresses were typed slightly wrong, Golding-Jewett said.

Likewise, the state health department last year wanted to know how well snail mail would work. It checked 68,610 addresses for Medicaid beneficiaries against addresses in its Michigan Disease Surveillance System and Michigan Care Improvement Registry and other databases.

Of those, 6,164 of the addresses mismatched between systems, according to an email to Bridge from MDHHS spokesman Bob Wheaton.

That’s worrisome, say Hanley at the state and others who are doing patient outreach.

For beneficiaries, the first step is updating addresses through the MiBridges portal or calling their local MDHHS office. 

“We’ve done so much work since (the Affordable Care Act) was passed to make sure people in Michigan are covered,” said Scott, at the Michigan Primary Care Association. “We don’t want to lose that work, and leave people without access to care. There needs to be a no-wrong-door effort here.”