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Millions of kids could lose Medicaid coverage when the pandemic ’emergency’ ends : Shots


Khloe Tinker, 5, was measured before her appointment at the Doniphan Family Clinic in Doniphan, Missouri. The clinic is the sole source for specialized pediatric care in its rural Ozark county.

Sebastián Martínez Valdivia / KBIA


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Sebastián Martínez Valdivia / KBIA


Khloe Tinker, 5, was measured before her appointment at the Doniphan Family Clinic in Doniphan, Missouri. The clinic is the sole source for specialized pediatric care in its rural Ozark county.

Sebastián Martínez Valdivia / KBIA

Kathreen Friend is a pediatric specialty nurse based in Doniphan, Missouri – a small town of about 1,800 people near the Arkansas border. Like lone pediatric specialist in Ripley County, she’s still extremely busy. She works long hours at a non-profit organization Missouri Highlands clinics, and to nearby schools for health checks.

“I see a huge amount of kids every day,” says Friend. “It makes for long hours and long days, but we try to let people take care of.”

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Friend’s clinic is located in a building that used to be a former county hospital, but the hospital closed in 2018. The clinic has a safety net that treats both insured and uninsured patients, co. noticed a variety of illnesses, from broken bones to ear infections to COVID-19.

Most of Friend’s younger patients are covered by Medicaid, a government health insurance program for low-income people. More than 2,200 children, out of a total population of 10,000 in Ripley County get some kind of public health insurance.

Millions of children across the United States rely on Medicaid for health insurance. Since the beginning of the COVID pandemic, federal emergency declaration has allowed them to receive coverage consistently – without having to re-register or jump through bureaucratic hoops.

In Missouri, overall Medicaid enrollment has increased more than 400,000 won since the beginning of the pandemic. That’s one of the largest per capita gains in the country, largely driven by the 2020 balloting referendum to expand Medicaid to more Missourians.

The states and the federal government divide the costs of Medicaid. Although many federal rules apply, states administer the program and have flexibility in deciding who qualifies for income-based coverage.

Before the pandemic, Medicaid recipients around the country routinely had to prove to their states that they still qualified for the program — that is, they had to show that their income was still low enough and that they weren’t. have access to other affordable insurance options. such as job-based insurance. This claim process is called redetermination, and can be time-consuming and cumbersome.

But after the Covid pandemic began, the federal government declare national public health emergency (PHE). That helped speed up the development of new vaccines and treatments, make Covid shots free, and relax rules around telehealth and other aspects of healthcare.

In the Medicaid program, redetermination was suspended under the PHE. After joining Medicaid, people will continue to be eligible without having to do anything.

The idea is to keep people covered when they might get sick during the pandemic, and provide relief from social and economic disruptions that would make redefining an undue burden – for both patients and government agencies.

But in Missouri, doctors and advocates are worried about the end of the public health emergency, and its impact on children in particular. That’s because the state has a clear track record when it comes to managing its Medicaid rolls, and making sure that eligible Missourians get – and keep – that coverage.

Missouri Fears Based on Past Issues

Dr. Maya Moodypresident of the Missouri branch of the American Academy of Pediatrics, pointing to an incident in the past, when the state removed about 100,000 children from Medicaid back in 2019.

Moody said: “I mean, we turned our backs on the kids and it just broke our hearts.

In that case, Missouri paused the redefinition to implement a new computerized system for administering Medicaid. As it continued to redefine, many children who remained eligible were unwittingly removed from the program.

“These are the children we need to see and they are our regular patients,” said Moody.

State officials later acknowledged the nature of the error: if a parent in a household doesn’t qualify for Medicaid coverage, their children automatically lose that eligibility, even though children do. have a different income threshold to qualify. State officials say they have fixed the bug.

The federal government renew public health emergency related to Covid on October 13, for another 90 days. That means the PHE could expire on January 11, 2023 – unless there is another renewal. When it’s over, all states will have to continue to regularly check who qualifies for Medicaid.

It will be a big, sudden step forward, say Sara Collinsa Commonwealth Fund senior economist and scholar.

“Countries will face the end of a public health emergency with the colossal task of redefining eligibility for people who have stayed in Medicaid for a period of time,” Collins said. these two years,” Collins said.

Another potential problem is that many people quit their jobs during the pandemic, so it’s unclear if states have the workforce needed for the task.

All these factors made Dr. Moody, a Missouri pediatrician, worried that her condition was not yet ready.

“These are families that we really know well, and so … one of the real blessings of the public health emergency is that we don’t have to turn anyone away.”

Moody’s fears many Medicaid patients – especially children – will be excluded from coverage or fall into bureaucratic loopholes. To prevent this, she tells Medicaid patients they need to be proactive in maintaining their coverage.

“We’ve started talking to people about making sure they’re gathering documents and ready to reapply” after the emergency declaration expired, Moody’s said.

How Missouri is ready – and how health care can help

Missouri’s readiness to handle the upcoming work remains a question. Following the expansion of Medicaid in 2021, Missouri struggled to process all new applications, and by February 2022, the average wait time reached 119 days – far exceeding the federal requirement of 45 days or less. State officials now say they have reduced the backlog of Medicaid applications, but do not disclose current average waiting times, except to say that it is now within the federal 45-day limit. .

However, pediatric advocates worry that extended processing times will mean children have to wait long for care or have gaps in their coverage. The federal government may decide in November to extend PHE for another 90 days beyond January 13, 2023. But even if that happens, most people agree it will be terminated by January 13, 2023. some time.

The federal government discussed the matter with the states and recommended that they approach the redetermination work gradually, dividing their Medicaid money into smaller chunks.

A spokesperson for the Missouri Department of Social Services said in an email that the agency is currently working to verify all addresses of Medicaid recipients, so when the time comes, they will receive the procedures. Necessary documents.

All that paperwork involved Friend, the pediatric nurse in Doniphan. She cares especially for her patients, who are covered for the first time during the pandemic and have never had to go through a redefining process.

“Now that’s easy… they’ll think they’re still covered,” Friend said.

She knows she is part of the solution and must educate her patients about insurance rules and talk to them about their health problems.

This story comes from NPR’s reporting partnership with KBIA and KHN (Kaiser Health News).

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