As Alaska works through post-pandemic Medicaid renewals, only about a third of people stay covered

When Brandy Barnes got the first notice that she might be dropped from Medicaid, she was worried. One of her teenage sons is autistic and needs significant care to lead a full life.

“My main concern is that my son is disabled,” she said. “He has therapies, medications, doctor appointments that cannot be dropped. I started asking around, and apparently this was happening to everyone.”

She said everything from his education to his bus pass are dependent on his Medicaid status. Barnes was proactive during the pandemic and updated her paperwork with the state. But this summer she got a letter that said she had a new case manager and that her paperwork was missing.

Barnes is trying not to join the thousands of Alaskans who were dropped from Medicaid because of paperwork problems. Only a third of Alaskans are staying covered as the Department of Health works through post-pandemic Medicaid renewals.

Part of the reason is that lots of people have issues with their paperwork. Over the last two months, 13,000 Alaskans have lost coverage for paperwork problems — enough that officials say they are sounding the alarm and the federal government has asked the state to pause dropping people for paperwork reasons because too many children may be losing coverage. Nearly 40% of the Medicaid recipients in Alaska are children.

A pause in disenrollments

The high number of people who are losing coverage for paperwork reasons has state and federal officials concerned. It is called “procedural disenrollment” and the number of them jumped substantially from June to August. Faulty or missing paperwork is the reason 40% of Alaskans lost Medicaid coverage for the months of August and September.

Deb Etheridge, the director of the Division of Public Assistance, said the state health department is increasing its outreach as a result.

“When we saw the high procedural disenrollment, we really kind of just reiterated sounding the alarm,” she said.

As a result of the number of people losing Medicaid for paperwork reasons, states got a letter from the federal government asking them to pause certain disenrollments until they could make sure eligible children are not losing care.

Etheridge said the division is seeking an in-depth analysis of who is getting dropped for paperwork reasons — if it is children, adults, or people who no longer use Medicaid.

“I’m concerned,” she said. “I want all providers and all individuals to have access to health care and Medicaid if they’re otherwise eligible.”

Procedural disenrollments are a tough metric for the state to improve, since the division is dependent on individual Alaskans to keep their information up to date, Etheridge said.

“That’s kind of been the hardest part of the game. We’re still calling people and asking them to return their forms,” she said.

Etheridge said it’s important that people give the state their correct address and open and then respond to their mail, so that the state can keep them enrolled in the program if they qualify.

Official paperwork is complicated

The process is difficult for the state to navigate, but also for individuals like Barnes. After she got the notice that said she may lose care, she tried to contact the new case manager. After weeks of attempts, she said she got another notice that her son may lose coverage. She went to a Division of Public Assistance office and worked with an employee to get all her paperwork filed. They were unable to contact her case manager.

Then she got another letter. It said the state hadn’t received her paperwork and her son would lose coverage — his daily help navigating the community, his medication, his weekly therapy. An advocate helped her turn the paperwork in again. She was notified that her case worker no longer worked for the state. Then she got a ton of backdated paperwork in the mail. All of it was weeks out of date — some of it was up to a year out of date.

One letter was a notification that she had a new case worker — the one who had already left, she said. Another said if her paperwork didn’t come in she would be denied Medicaid. Another said she was missing part of her paperwork and would be denied coverage.

The letters said her coverage would end after the end of July. She’s filled her medications and her son is going to therapy. She said she’s waiting to see if she gets a Medicaid card in the mail — or a bunch of bills. She is still waiting for a new caseworker.

“This is common amongst different people that I talked to that have disabled children,” she said. “In the autistic community, I know quite a few parents and they’re all struggling with similar issues.”

State fixes

Division Director Etheridge said the state is keeping up with paperwork, but there can be confusion if people are too proactive and send in paperwork before the state asks for it. Alaskans can update their contact information with the state at any time, however. And as far as case workers go, she said there are currently a couple of vacancies.

The health department is taking significant steps to reduce the number of people who fall off the Medicaid rolls because they have not updated their paperwork.

Etheridge said the division has plans to change the appearance of the envelopes it uses for notices, so that Alaskans won’t mistake the state’s communication for junk mail. She said the health department is reaching out to health care providers to ask them to remind patients about the renewals and the need to update their information to avoid getting dropped for paperwork reasons. In state airports, the Department of Health has televised reminders for Alaskans to update their information to stay enrolled in health care.

Etheridge said that if someone’s Medicaid benefits are stopped in error, the state can reissue them retroactively for up to 180 days.

Barnes said she feels lucky. She said even though the state notices say her son may lose Medicaid, she hasn’t yet gotten bills for his care — even though she hasn’t gotten a Medicaid card either.

Originally published by the Alaska Beacon, an independent, nonpartisan news organization that covers Alaska state government.