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Millions of Americans Lose Medicaid Coverage Due to Administrative Errors

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Millions of people across the country have lost their Medicaid benefits after a pandemic-era mandate for coverage expired in March. Many of these individuals were dropped from the program due to administrative errors unrelated to their actual eligibility. The Biden administration and state officials had anticipated complications in the unwinding of the continuous enrollment requirement, but the lapses have still had life-altering consequences for those affected.

A Devastating Loss

Beverly Likens, a disabled resident of Kentucky, found herself in a dire situation when her Medicaid coverage ended just days before her scheduled surgery. Likens, who suffers from severe anemia and chronic uterine bleeding, feared that she would spend the rest of her life needing blood transfusions. She believed she had followed all the necessary steps to maintain her eligibility and was shocked to discover that she no longer had coverage.

Technological Errors and State Missteps

Likens' coverage gap was caused by technological errors in Kentucky's eligibility system and missteps by the state. Her attorney, Cara Stewart, tried to submit a new Medicaid application for Likens before her coverage expired but encountered difficulties with the online system. The state's failure to consider all scenarios in which Likens might qualify for Medicaid violated federal regulations. Despite these errors, Kentucky health officials maintain that they did nothing wrong.

Medicaid Eligibility and SSI

Likens initially qualified for Medicaid because she received Supplemental Security Income (SSI), a program for individuals with little to no income or assets who are blind, disabled, or elderly. After being informed by the Social Security Administration that she was no longer eligible for SSI, Likens received a notice from a Kentucky agency stating that her health benefits would automatically stop. The state did not assess whether she qualified for Medicaid based on other factors and directed her to reapply.

A Failure to Reassess Eligibility

Kentucky's failure to reassess Likens' eligibility for Medicaid in another way before terminating her coverage is in direct violation of policy guidance issued by the Centers for Medicare & Medicaid Services (CMS). The state's explanation for their actions has been deemed "absolutely wrong" by disability advocates. Likens' case highlights the risk of individuals falling through the cracks during the Medicaid "unwinding" process.

The Consequences of Administrative Errors

Likens faced significant challenges in regaining her Medicaid coverage, including technological errors in Kentucky's online system. It took multiple phone calls and constant persistence to have her coverage reinstated. While Likens was fortunate enough to have her surgery in July, she worries about others who may not be as lucky. She believes that it is unfair for any Kentuckian to go without healthcare.

A Call for Improved Medicaid Enrollment Processes

The widespread loss of Medicaid coverage due to administrative errors highlights the need for improved enrollment processes. States must prioritize automatic renewals and ensure that individuals are not dropped from the program when they should still be eligible. The Biden administration and state officials must work together to address these issues and prevent further disruptions in healthcare access for vulnerable populations.

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