Medicaid is the public health insurance program mainly for low-income people. It also covers some of the elderly and disabled population. At its height earlier this year, Louisiana's Medicaid enrollees ballooned to over two million — about 45 percent of the population. That's about 450,000 more than what was typical for the state before the pause.
States have begun the so-called "unwinding" process across the nation. So far, 3 in 4 Medicaid patients in Louisiana have lost coverage due to "procedural reasons" — technicalities like paperwork, incomplete renewal packets or outdated contact information. But many have been able to re-enroll.
"Some people are able to reapply and get back on and it's not an issue," said Courtney Foster, Medicaid policy advocate for the Louisiana Budget Project. "But we know when there is a discontinuity in coverage, that can have an impact on if people go to the doctor because of the confusion around if they may have to pay."
In children, that could lead to educational and developmental delays that are harder and more expensive to address the longer they are allowed to fester, advocates said. Seven in ten children in Louisiana were covered by Medicaid by early this year. Only New Mexico has a higher rate of children who rely on Medicaid for health care.
'Much Harder to Fix'
"Any decline in that is problematic, and we've actually been watching the rates of children's insurance go down for several years prior to this," she said.
Kids who don't have health insurance might not be able to get a doctor's appointment for their typical check-ups and vaccines. That results in a loss of the screening processes — things like hearing, vision and balance — that identifies when children are falling behind on developmental milestones, said Nelson.
"What we're going to see is children down the road with profound educational delays that are much harder to fix in third, fourth, fifth grade," said Nelson.
Some states, such as Maine, provide continuous coverage for kids up to age 6 if they qualify for Medicaid at any point. Louisiana covers kids for 12 months once they qualify, then they have to re-enroll. For parents with multiple children enrolled at different times, that can be taxing, said Nelson.
Children have typically made up a small portion of Medicaid spending. In 2019, CHIP, the program that covers children when their parents make slightly too much to qualify for Medicaid, accounted for 3 percent of the $12.4 billion-dollar budget.
The federal government covers a large portion of Louisiana's Medicaid costs, usually between 70-74 percent. Next year, for every dollar it spends, Louisiana will receive about $1.67 from the federal government.
Louisiana has made more of an effort than most states to renew Medicaid beneficiaries automatically, using state wage databases to check for eligibility before kicking someone off. About 80 percent of the state's renewals were through this "ex-parte" process, compared to a 56 percent national average, according to a report from the Kaiser Family Foundation.
Of the nearly 162,000 people who have lost Medicaid in Louisiana as of the end of August, about 28,300 have re-enrolled, a process called "churning." Of those, about 15,200 are children.
State representatives reaching out to families have run into address changes and phone calls that go unanswered. Many Louisiana residents moved over the last three years due to change in financial status or after a number of hurricanes hit the state. Rural residents have been especially hard to reach, said Erica French, Southeast Louisiana Community Outreach Coordinator. That's led to the high number of people falling off for procedural reasons.
The state has a disenrollment rate of 37 percent, landing it somewhere in the middle for the number of residents taken out of the program. Comparatively, states such as Texas, Idaho and Montana have disenrolled over 60 percent of people who receive Medicaid.
"It's nice that Louisiana is doing better than other states," said Foster. "We still could be doing better."
The state did not answer questions about how reenrollments affected the total fluctuation of children on Medicaid.
People looking to renew their Medicaid coverage can call 1-888-342-6207 or visit swlahec.org/navigators for assistance.
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