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Medicaid warns 5 states that they've made it too hard for residents to keep coverage


The federal government has put five states on notice that they make it too hard for people to stay on Medicaid. States share the expense of Medicaid with the federal government, and it's often among their biggest budget items, so states have incentive to keep rolls thin. And when COVID-19 hit, states had to keep everyone on the rolls. But now that rule has expired. And many federal regulators say some states may be denying benefits to too many people. Montana Public Radio's Austin Amestoy reports.

AUSTIN AMESTOY, BYLINE: During the pandemic, the number of people on Medicaid nationwide swelled to more than a quarter of the U.S. population. That's in part because for three pandemic years, the federal government stopped making people prove that their incomes remained low enough to be eligible for Medicaid coverage.

AUTOMATED VOICE: You have reached the Montana Public Assistance Helpline.

AMESTOY: Keli Whithorn is trying to get back on Medicaid in Montana.

AUTOMATED VOICE: To speak with someone, press zero.


AMESTOY: Whithorn is 42 and lives in a small town north of Yellowstone National Park. She found out she lost coverage in July when her pharmacist told her Medicaid was no longer paying for her heart failure medications. Now she has to put that $700 a month on her credit card.

KELI WHITHORN: It was just like a punch in the gut.

AMESTOY: Whithorn has spent countless hours trying to get a real person to pick up the phone so she can prove her income hasn't changed and she's still eligible.

AUTOMATED VOICE: Did you know that you can request a callback so that you don't have to wait on hold?

AMESTOY: She wasn't able to get through today and had to make an appointment for a call a week later. Montana's 42-minute average wait time for its Medicaid call center is one of the worst in the nation. Only Missouri's is longer. About 40% of people who call Montana's helpline abandon their calls, a rate higher than most states, Medicaid says. But Whithorn says she has to keep trying.

WHITHORN: I feel like I was swimming with both of my arms and legs. And losing the Medicaid makes me feel like they've, like, cut off one of my legs. And now I'm just, like, floundering around in the water.

AMESTOY: Montana's Department of Health declines to answer questions from the press about long wait times and abandoned calls. In an emailed statement, it says it's complying with federal rules, but federal Medicaid authorities say they may not be. Medicaid also says Montana is at the bottom of the pack when it comes to reenrolling people who remain eligible for coverage, along with New Mexico, Alaska, Rhode Island and Florida. Those five states have also disenrolled a relatively high number of people, which is concerning, says Jennifer Wagner with the Washington, D.C., think tank Center for Budget and Policy Priorities.

JENNIFER WAGNER: We don't know why somebody lost coverage. We don't know if they remain eligible. And many times those individuals are still eligible.

AMESTOY: Wagner says the problems Medicaid has identified in the five states, including Montana, could indicate they're not reenrolling people who are still eligible for health coverage.

WAGNER: And so hopefully when we see these concerning data, it's an opportunity to intervene and say, hey. Here are some options that you haven't taken. Let's get things straightened out.

AMESTOY: The statement from Montana's health department says a, quote, "small proportion of people are losing coverage due to mail issues," unquote, but contends that most people who don't return paperwork would no longer qualify. For Keli Whithorn, the Montana resident who says she was mistakenly kicked off Medicaid, knowing that federal regulators have identified potential problems here is slim consolation.

WHITHORN: Knowing that I'm not alone - like, it helps a little bit, but it also hurts. This should not be happening.

AMESTOY: Whithorn will be able to ask for retroactive coverage of medical expenses, but she'll still be responsible for the interest accruing on her credit card. And she says nothing will replace the canceled doctor's appointments she depends on to stay healthy. For NPR News, I'm Austin Amestoy. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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