Frequent Medicaid Disruptions Aggravate Health Issues for Homeless People
Dominique Anthony made a routine visit to the pharmacy recently and was surprised to find that the essential daily medication needed to treat her HIV would not be covered by her insurance. To her knowledge, she had not received notice that her Medicaid coverage had expired, yet she was informed at the pharmacy that her insurance had lapsed.
Medicaid has an annual renewal process to verify that individuals are still eligible to receive benefits. For most people who qualify for a category of Medicaid coverage based on modified adjusted gross income, or MAGI, this is simply “passive renewal,” which is automatic renewal of Medicaid coverage. This means that many people have their insurance renewed without having to go through additional steps or provide paperwork.
If the automated system finds questions pertaining to an individual’s eligibility status or if there is a need for documentation, the system sends a number of notifications to the person’s home address with instructions on how to renew coverage. After the expiration date, there is a 90-day grace period during which individuals can recertify their coverage without having to reapply altogether.
But for individuals like Anthony, who are homeless or experiencing housing instability, mailed notifications or automated phone-call reminders are not reliable methods of contact.
According to D.C. Medicaid Director Claudia Schlosberg, about 75 percent of the 260,000 individuals covered by Medicaid in D.C are eligible through the MAGI category. Schlosberg said that 90.3 percent of individuals with MAGI-related coverage whose insurance was set to expire in the between January and May have had their coverage passively renewed. This means that 3,185 individuals were not passively renewed, though their coverage was not necessarily terminated if they were able to supply the additional requirements.
Dr. Anne Cardile, the medical director at Unity Health Care’s clinic at Community for Creative Nonviolence (CCNV), pointed out that when passive renewal does not go smoothly, the problem can be substantial. She said she and other health care providers see housing-unstable patients every day whose Medicaid coverage has lapsed because they do not have a fixed address and may never see a notice.
“Their lives are so chaotic with just trying to keep up with other things — food, shelter — that even if they have notice of it, it can be overlooked because other things take priority,” Cardile said. “So it happens every day.”
As an example, Cardile described a patient she has been seeing for many years, a man who has diabetes and requires daily insulin to control his blood sugar. Though he works for a construction company, he experiences homelessness. His insurance paperwork is not always up-to-date and he sometimes does not keep up with his visits to the doctor. This person often goes for several days without insulin and other needed medication.
“He has difficulty making sure that his Medicaid is always active because it requires the documentation, and his life is just chaotic,” Cardile said. “He’s trying to make sure he has food in his mouth and knows where he’s going to sleep that night and that type of thing.”
Medicaid rules allow pharmacies to dispense emergency three-day supplies of medications at no cost to patients when coverage may have lapsed. When coverage is reinstated, Medicaid reimburses the cost of the medication. These rules include restrictions to dispensing a three-day supply, including if “there are clinical issues that must be resolved” or if “the rejection is due to an error that only the provider can correct,” according to a Medicaid notice on pharmacy services.
However, Cardile said that some individuals who come to CCNV and experience homelessness may not be able to access pharmacies due to chronic mental health issues that cause difficulties interacting with others. Additionally, some individuals come to the clinic whose medical situations are too severe to take the extra step of going to a pharmacy.
The clinic at CCNV is one of many Unity Health centers that has a cache of medications available to help alleviate some of the strains that disruptions in insurance coverage can cause. These medications are available to people experiencing homelessness without insurance or without the ability to access a pharmacy. The store of medication is sponsored in part by the D.C. Department of Behavioral Health and was established for individuals who are homeless and who have mental health issues.
“It’s a tremendous blessing for us certainly and for many of our patients. Without it we would just be in desperate situation after desperate situation,” Cardile said.
When patients do experience lapses in coverage due to missed paperwork, Cardile said Medicaid is usually very quick to respond to the inquiries filed by Unity Health’s social workers, who work to help clients stay linked to insurance. She noted that the process still takes a few days.
“I can’t get my HIV medicine right now without insurance,” Anthony said after three days without her medication. “[I have to take my medication] every day because it’s going to save my life. I called my doctor and asked my doctor if she could give me some samples of my medicine. She said she don’t have any. That’s crazy.”
Anthony scheduled an appointment with the Department of Human Services to restore her coverage. The process could take up to 30 days after her appointment because her coverage had expired. Anthony reported having two seizures after a week without her medication.
When Street Sense inquired about Anthony’s situation, Schlosberg looked into her case and discovered that her coverage had been terminated by mistake, most likely due to human error. Her coverage was reinstated within a day, and a three-day supply of medication was authorized.
Schlosberg said the best thing individuals can do if they discover their Medicaid coverage has lapsed due to an error or a missed notice is to go online at dchealthlink.com/individuals/renewalD2, call (855) 532-5465, send the renewal form through the mail or visit one of the service centers in person.
“The Department of Health Care Finance, working in collaboration with the Department of Human Services Economic Security Administration, is committed to ensuring that all District residents who are eligible for Medicaid are able to access and maintain their benefits,” Schlosberg wrote in an email to Street Sense. “We continue to upgrade and make improvements to our service centers and to work toward the full automation of our eligibility systems.”
Cardile believes that increased awareness of how difficult it is for homeless individuals to stay linked to insurance is key to improving the system. For the client with diabetes, for example, lapses in insurance have led to problems with blood sugar control.
“None of that would have to happen if his insurance were active all the time — and with ease — because he could make sure he had refills. It’s a constant issue for him,” Cardile said.
Medicaid renewal forms can be submitted at any of the following service centers:
Anacostia Service Center
2100 Martin Luther King Avenue, SE
Washington, DC 20020
Congress Heights Service Center
4001 South Capitol Street, SW
Washington, DC 20032
Fort Davis Service Center
3851 Alabama Avenue, SE
Washington, DC 20020
H Street Service Center
645 H Street, NE
Washington, DC 20002
Taylor Street Service Center
1207 Taylor Street, NW
Washington, DC 20011