As a result of the public health emergency declared in response to the COVID pandemic, many more people are enrolled in Medicare and Medicaid. But, as soon as July, the Biden administration is likely to end this emergency, and many dual-eligibles could lose their Medicaid coverage. Erin Weir Lakhmani of Mathematica reports in Health Affairs on the challenges dual-eligibles face and how to address them.
Today about 12 million people have both Medicare and Medicaid. They are at particularly serious risk when states make redeterminations regarding their Medicaid eligibility. They tend to have multiple chronic conditions and to use long-term services and supports, including home care services and nursing home care, which Medicare does not cover.
Without Medicaid, many of these people will be cut off from long-term services and supports. Medicaid support often enables them to age in place, remaining in their homes rather than having to move into a nursing home.
Dual-eligibles are also more likely to struggle with renewing their Medicaid applications. Many have Alzheimer’s disease or another type of dementia. And, many have low health literacy levels and might not understand Medicaid renewal notices even if they don’t have dementia. They will need help, which can be hard to come by.
As a general rule, dual-eligibles lose Medicaid because they cannot manage the recertification process not because they no longer qualify. The issue isn’t a change in assets or income. They struggle to overcome the barriers and requirements their states impose to gain Medicaid eligibility.
States are required to use ex parte processes to renew people’s Medicaid, if possible, and not depend on dual-eligibles to complete forms. But, they tend not to use ex parte processes as much as they might. In order to determine whether people do not exceed asset limits, states tend to ask dual-eligibles to respond to requests to renew their Medicaid eligibility.
When dual-eligibles lose Medicaid, they can suffer profoundly. They might forego or otherwise not be able to get important medical care if they lose Medicaid wrap-around coverage. In the long-term, that can raise costs for the states as it can lead to severe health consequences.
What can be done?
- If you receive Supplemental Security Income (SSI), the Social Security Administration can determine Medicaid eligibility for you in 34 states.
- States should use ex parte reviews more often.
- States could also check to see whether dual-eligibles who are losing Medicaid qualify for Medicare Savings Programs, such as QMB or SLMB and Q-1 that help offset Medicare costs.
Here’s more from Just Care:
Leave a Reply