Between treatment costs for her kidney disease and his spinal surgeries, Shiloh and Denis Velez, both disabled and out of work, can’t afford to lose their Medicaid benefits. So, they didn’t tarry when they learned those benefits would cease if they didn’t recertify their eligibility with the state before the federal public health emergency ends.
There are nearly 90,800 other Granite Staters who haven’t done the same and risk finding themselves at a doctor’s office or pharmacy suddenly with no insurance – even when they still qualify for benefits. And that’s despite a massive outreach campaign by the state Department of Health and Human Services and dozens of organizations that work with low-income people.
Shiloh Velez, 47, of Merrimack, is sounding the alarm too, sharing Facebook alerts from NH Healthy Families.
“I don’t want to see people suffer or go without,” she said. “If it doesn’t have to happen, then it shouldn’t. Why suffer?”
Medicaid enrollment surged nationwide when the pandemic and a child care shortage forced people out of work, leaving them in need of financial assistance. In New Hampshire, which has 240,517 Medicaid beneficiaries, standard Medicaid enrollments have increased 20.1 percent, while expanded Medicaid has seen a 73.5 percent increase since March 2020.
The federal government gave states extra money to cover the enrollment increases – but with a catch.
States were required to keep everyone enrolled – without the standard annual eligibility review process – until the end of the federal public health emergency. That is set for October, but the deadline has been extended several times since January 2020 and could be again.
The state’s Division of Medicaid Services has opted to act before that deadline prompts thousands of desperate calls for help.
Staff have been meeting weekly since early 2020 to remind Medicaid recipients to renew their eligibility before they discover too late that they no longer have coverage. That campaign has included texts, emails, phone calls, community events, social media, and a nationally recognized “pink letter campaign.”
There are about 90,800 Granite Staters who risk losing their Medicaid coverage for one of three reasons: they have aged out and are eligible for Medicare, they have not renewed their eligibility, or they earn too much to qualify. Those in the last group can work with one of the Insurance Department’s “navigators” to explore other options, including public insurance.
“I think a lot of us are in this work because we want to help people,” said Henry Lipman, the state’s Medicaid director. “Just letting people lose coverage because they don’t know what to do didn’t seem like the right thing to do. My perspective on this is that we want to make sure that when (the federal health emergency) has ended, nobody that should be covered loses their benefits.”
Lipman’s use of “should be covered” is a reference to the state’s role as a steward of taxpayer dollars. “We have a financial responsibility to make sure the state is not paying for coverage that we should not be paying for,” he said.
Pulling out all the stops
In May, the national Center on Budget Policy and Priorities held a press briefing, urging states to take a number of steps ahead of the public health emergency expiration to minimize a loss of health coverage for their most vulnerable residents.
“This is an opportunity for states to adopt these approaches and improve their systems for both the short- and long-term benefit,” Farah Erzouki, a senior policy analyst at the center, said then. “States now have the time to get it right, and it’s time for them to get it right.”
Reached last week, Erzouki gave the state kudos.
“It’s really great to see that New Hampshire is doing … a lot of the things that I think will ensure success at the state level and making sure that people are aware of what’s to come,” she said.
One of its initiatives – the “pink letter campaign” – was held up by National Association of Medicaid Directors and the federal Centers for Medicare and Medicaid Services.
The “nudge” letter, printed on pink paper to draw attention, warns recipients of a potential loss of benefits if they do not renew their eligibility before the end of the federal health emergency. So far, the state mailed 75,000 letters and as of mid-June had renewed eligibility for 23 percent of beneficiaries. (The actual number of renewed people is higher because some households have more than one person receiving Medicaid.)
It’s one of the many ideas to come out of the department’s weekly meetings.
The division also sent 14,500 emails and texts between March and June to recipients who had moved and not updated their address. About 1,800 responded.
It has funding to hire up to 33 temporary workers to staff a helpline to reduce wait times. Its social media campaign has included graphics partners can share on their own channels.
Health and Human Services staff called every Medicaid recipient who lives in a long-term care facility or is elderly or disabled. They reached 66 percent of those people and succeeded in renewing eligibility for 55 percent. They did the same for households with children, reaching 46 percent of those recipients and renewing eligibility for 37 percent.
It has provided organizations such as mental health centers and others that work with low-income people the names of their clients on Medicaid so they can reach them directly.
The department is encouraging Medicaid beneficiaries to renew eligibility online through NH Easy (nheasy.nh.gov), a portal to several sources of assistance. That effort has led 62 percent of Medicaid households with a NH Easy account to renew eligibility, 54 percent of whom are homeless. (Help is also available by calling 1-844-275-3447.)
Those efforts have led to 30,000 households renewing their eligibility ahead of the deadline.
“We are trying to pull out all the stops to reach people,” Lipman said. Continuous deadline extensions have allowed the division to try lots of approaches and circle back to those who don’t respond. “We realize that we are not in a sprint. We’re in a marathon. That’s the plus side of having more time to get to more people.”
The outreach has also included more than 50 community events, often in partnership with other service agencies. In mid-June, the Medicaid staff, laptops in hand, joined NH Healthy Families in Portsmouth for its monthly distribution of free food. In under 15 minutes, Medicaid recipients could renew their eligibility and fill a grocery bag.
Michelle Fraser, a NH Healthy Families volunteer at the Portsmouth event, was glad to see the state there.
“There’s a lot of confusion out there in the community right now,” she said.
Elias Ashooh, executive director of Health Market Connect, agrees. His organization’s “navigators,” some of whom joined Ashooh in Portsmouth, are helping people who no longer qualify for Medicaid enroll in federally subsidized public health insurance.
“Something that has surprised me is the real fear amongst people,” Ashooh said. Some, he said, are ignoring the outreach because they think they are in trouble with the state. “They don’t understand what’s going on with all of this.”
An opportunity to improve
New Hampshire Legal Assistance’s work with low-income people puts it in touch with Medicaid recipients. Attorney Ray Burke said staff are urging those clients to renew eligibility and preparing for a surge in calls when people suddenly lose coverage.
Meanwhile, NHLA’s client advocacy has been directed at urging the state to make Medicaid eligibility renewals easier now – and after the pandemic.
They aren’t alone.
In its January study of Medicaid access in New Hampshire, the Center for Popular Democracy, a progressive advocacy group, found that nearly 60 percent of respondents said they encountered barriers when trying to renew eligibility that included no access to a computer or smartphone, long waits when they called for help, lack of transportation to a state office, missing paperwork, and uncertainty about the process.
Erzouki at the Center on Budget Policy and Priorities said the changes New Hampshire and other states were forced to make during the pandemic are an opportunity: “A lot of states might need to re-examine (their Medicaid renewal) policy that they probably haven’t looked at for a really long time and see where those gaps are and how they can use different strategies to improve.”
Burke thinks the pink letter campaign and other outreach have been good initial steps.
The state could continue making improvements by doing more “ex parte renewals” where it uses existing government data to confirm someone remains eligible for benefits without making them submit to an annual review, Burke said. The online portal could be easier to use if the state issued security pin numbers more quickly. And while call wait times have improved, there is still a wait, Burke noted.
As the deadline nears and pressure mounts to determine Medicaid eligibility for thousands quickly, NHLA is concerned people who are eligible for benefits will be mistakenly denied. Burke said they’ve asked the state to consider auditing denials to catch mistakes.
Some of that will require significant changes to the state’s data systems and possibly additional funding, two hurdles at a very difficult time.
“None of this is easy,” Burke said. “And I think there are some legitimate concerns on the state’s part.”