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Medicaid Mystery: Millions of Enrollees Haven’t Materialized in California
Kaiser Health News ^ | 7-23-2020 | Rachel Bluth, Angela Hart

Posted on 07/23/2020 4:57:33 PM PDT by spintreebob

The predictions were dire: Coronavirus lockdowns would put millions of Americans out of work, stripping them of their health insurance and pushing them into Medicaid, the health insurance program for low-income people.

In California, Gov. Gavin Newsoms administration projected that the pandemic would force about 2 million additional people to sign up for the states Medicaid program, called Medi-Cal, by July, raising enrollment to an all-time high of 14.5 million Californians — more than one-third of the state’s population.

But July is almost over, and Medi-Cal enrollment has hovered around 12.5 million since March, when the pandemic shut down much of the economy — though enrollment ticked up in May and June, according to the latest data from the state Department of Health Care Services, which administers the program.

Essentially, enrollment hasn’t budged even though nearly 3 million Californians are newly unemployed.

Its a mystery, said Anthony Wright, executive director of Health Access California, an advocacy group for health consumers. We have lots of plausible explanations, but they dont seem to add up.

Even the state is stumped. The enrollment data is preliminary, and Medi-Cal officials expect the numbers to grow as eligibility appeals and other unusual cases are resolved, but not by 2 million people, said Norman Williams, spokesperson for the Department of Health Care Services.

The department based its projections on the states experience with the Great Recession a decade ago, a comparison that it now acknowledges was misguided because the pandemic did not spur a purely economic crisis. The state failed to predict people would avoid care at clinics and hospitals during this public health crisis, and thus be less likely to need coverage immediately.

The current situation is far more complex because it involves both economic and health decisions, creating a more complicated picture more closely related to that seen during the 1918 influenza pandemic, Williams said in a prepared statement.

Even with the faulty comparison, its not clear why more Californians havent enrolled, he said.

The state prepared an estimate based on the best data available, during an unprecedented and rapidly evolving situation, he said.

The miscalculation meant the state likely allocated more money to Medi-Cal than the program now needs, even as lawmakers struggled to find ways to prevent deep health care cuts and close a massive $54 billion budget deficit as they negotiated the 2020-21 state budget in May and June.

And a more accurate estimate could have potentially funded new programs, such as expanding Medi-Cal to unauthorized immigrants age 65 and up, some state lawmakers and advocacy groups said.

Newsom backed that expansion of Medi-Cal, estimated to cost $80.5 million in the first year, in his January budget proposal but abandoned it in May, citing California’s financial crisis spurred by the pandemic.

We are talking about life-or-death services, so to say Im frustrated is putting it mildly, said state Sen. Holly Mitchell (D-Los Angeles), who chairs the Senate budget committee and leads budget negotiations in the upper house. Its irritating to me that they can be so off.

The new state budget puts Medi-Cals overall cost at $115 billion, of which $2.4 billion in state money has been earmarked for caseload growth. Yet it’s unclear how much of that could have been available to fund other programs or stave off cuts had the caseload projection been more accurate, department officials acknowledged.

Most states predicted their Medicaid enrollment would rise due to the pandemic, though many are seeing similar delays in Medicaid sign-ups, said Cindy Mann, a partner at the legal and consulting firm Manatt Health who served as federal Medicaid director for the Centers for Medicare & Medicaid Services during the Obama administration.

Washington state, like California, hasn’t seen its Medicaid caseload grow as expected, said MaryAnne Lindeblad, its Medicaid director. It projected up to 95,000 people would join the program by now, yet it has seen 80,000 new enrollees since March.

Its been a little bit surprising, she said. Theres so much going on in peoples lives right now and signing up for Medicaid doesn’t seem to be one of them.

Yet a record number of Americans have lost health insurance as a result of the COVID-19 pandemic and corresponding economic crash, according to a new report from Families USA, a national health advocacy group. California experienced the largest increase in newly uninsured residents of any state so far when an estimated 689,000 people lost coverage between February and May this year, the study shows.

Its a different kind of downturn and that might explain some of the reason we’re seeing lags across the country, Mann said. But unless unemployment numbers turn around dramatically, which is not the prediction, I think we will see the number of uninsured people continuing to grow and turn to the program.

There are several theories about why Californians who have lost their jobs during the pandemic have not yet enrolled in Medi-Cal.

For one, signing up for food and housing assistance appears more urgent than signing up for Medi-Cal, Williams said.

The pandemic has also created new sign-up hurdles. With libraries, schools, community centers and county health care offices largely closed during lockdowns, uninsured residents have had fewer places to enroll. Hospitals and clinics also frequently enroll uninsured people into the program, but many healthy people are avoiding treatment for fear of being infected with COVID-19.

And those who have lost jobs may still have work-based coverage because employers planned to rehire them and kept them on job-based insurance plans, or because theyve signed up for COBRA insurance temporarily.

Enrollment could also be lagging because the service industry has been hit hard, and many low-income workers in restaurants, bars or salons were already enrolled in Medi-Cal.

About a quarter who were at risk of losing jobs were already enrolled when the crisis started, said Laurel Lucia, director of health care programs at the Center for Labor Research and Education at the University of California-Berkeley.

Vanessa Poveda, 28, wasnt among the service workers already enrolled in Medi-Cal when the crisis hit. Instead, she had health insurance through her job as a server at Bartlett Hall, an upscale gastropub near San Francisco’s Union Square.

When Poveda was laid off during the first round of coronavirus closures in March, the restaurant extended her health coverage for 30 days before it expired, she said. Now unemployed and uninsured, she thinks she probably qualifies for Medi-Cal but hasnt signed up.

I havent really gotten around to it, she said.

Because Poveda is relatively healthy, she said, enrolling in coverage isn’t as urgent as some of her other needs.

Medical insurance is definitely a top priority for me, she said, but I also need a roof over my head.

In California, another factor may be at play. The Trump administration’s public charge policy may be having an outsize impact on Medi-Cal enrollment because of the state’s large immigrant population, said Hamutal Bernstein, a researcher at the Urban Institute. The rule allows federal immigration officials to more easily deny permanent residency status to those who depend on certain public benefits such as Medicaid.

A lot of immigrant families are being disproportionately impacted by economic and health hardship and are increasingly needing some of this assistance,” Bernstein said. But a lot of people are afraid of getting any kind of help.

Federal rules also prevent the state from kicking anyone off Medicaid during the pandemic, which means people who normally would have fallen off the program will stay enrolled, contributing to the states inflated projections, Williams said.

The department said it is working to get out the word that Medi-Cal is available, but Mitchell is urging the state to do more.

Im concerned not enough outreach is being done, she said. We expect people to magically know they may qualify for Medi-Cal and they should go online and apply.


TOPICS: Business/Economy; Crime/Corruption; Culture/Society; News/Current Events
KEYWORDS: california; coronaviruslockdown; economy; economylockdown; medicaid
Mysteries of Science: Why do people vote against their own self-interest? Why do so many of Mexican Heritage refuse food stamps and Medicaid? And now this: Why do temporarily unemployed miss all the free stuff they have coming to them?

What is this world coming to?

1 posted on 07/23/2020 4:57:33 PM PDT by spintreebob
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To: spintreebob

Perhaps their projections were based on inflated voting rolls? After all, dead people don’t usually sign up for Medicaid.


2 posted on 07/23/2020 5:11:51 PM PDT by the_Watchman
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To: spintreebob

Something funny about Medicaid.

Montana’s Governor hasn’t been handing out the federal money and he’s running for the US Senate.

Odd.


3 posted on 07/23/2020 5:14:44 PM PDT by blueunicorn6 ("A crack shot and a good dancer”)
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To: spintreebob

The go on Medicaid and the Government can take all your life savings thing ,LOL


4 posted on 07/23/2020 5:31:26 PM PDT by butlerweave
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To: the_Watchman
After all, dead people don’t usually sign up for Medicaid.

But they vote democrat.

5 posted on 07/23/2020 5:40:41 PM PDT by Don Corleone (The truth the whole truth and nothing but the truth)
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To: spintreebob

Uh-oh


6 posted on 07/23/2020 5:42:36 PM PDT by ncpatriot
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To: spintreebob

So 2 million people have left the state.


7 posted on 07/23/2020 5:50:45 PM PDT by <1/1,000,000th%
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To: the_Watchman

After all, dead people don’t usually sign up for Medicaid.

************

Oh sure they do. And they go to “doctor visits” too. There’s a good swath of the “medical industry” that depends on these no cost cash cows.


8 posted on 07/23/2020 5:54:15 PM PDT by Grimmy (equivocation is but the first step along the road to capitulation)
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To: butlerweave

Many or even all states that expanded Medicaid have waived estate recovery.


9 posted on 07/23/2020 5:59:00 PM PDT by steve86 (Prophecies of Maelmhaedhoc O'Morgair (Latin form: Malachy))
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To: the_Watchman

Dead people not on Medicaid? Social Security this week announced that Dead people receive Medicare. Do a FOIA in your state and find out how many dead receive Medicaid. Youo might be surprised.


10 posted on 07/23/2020 6:12:05 PM PDT by spintreebob
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To: the_Watchman

I know many folks here don’t believe the virus is a real threat, but what is important is that most Californians are afraid of it.

That means they do not want to visit doctors or pharmacies or hospitals or even smaller health care practices where other places where contagious sick people hang out...

No need for Medicaid....


11 posted on 07/23/2020 6:34:11 PM PDT by cgbg (Masters don't want slaves talking about masters and slaves.)
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To: the_Watchman

Don’t give them ideas! :-D


12 posted on 07/23/2020 7:12:51 PM PDT by BradyLS (DO NOT FEED THE BEARS!)
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To: spintreebob
Why would you sign up?

You can't use it.

And a lot of the low income people are in "vital" jobs. Their jobs, stocking shelves, working in factories, even fast food, their jobs are still there.

13 posted on 07/23/2020 7:16:07 PM PDT by Harmless Teddy Bear (And lead us not into hysteria, but deliver us from the handwashers. Amen!)
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To: Harmless Teddy Bear

Low Income jobs still there?

Not in states with lockdown. Almost all of us white collar types can work from home, and are. Very few of us are laid off.

Low income restaurant, health care, service jobs that don’t fit WFH are hardest hit.

I find it interesting that D politicians propose programs and run ads with lip service to jobs. But their programs are job killers.


14 posted on 07/24/2020 5:46:31 AM PDT by spintreebob
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To: spintreebob
Yes in states with lock down.

Fast food is still open. If anything it has grown. Pizza is through the roof.

Big box stores are still open. And they need more people then ever.

Factory and warehouse jobs the same.

Wait staff are not needed so much but a number of sit down restaurants remain open for take out and delivery.

Low income healthcare jobs are still there as well.

15 posted on 07/24/2020 9:24:40 AM PDT by Harmless Teddy Bear (And lead us not into hysteria, but deliver us from the handwashers. Amen!)
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