Why Medicaid recipients removed a mystery

More than 700,000 Ohioans were removed from the state’s Medicaid program in just the first 10 months of 2018.

Franklin County had the most disenrollments, with nearly 90,000 losing the health-care coverage from January through October, the most recent data available show.

But no one quite knows why such a huge shift took place in the state-federal program for low-income Ohioans.

The total Medicaid enrollment statewide was 2.8 million as of October, so 700,000 amounts to a quarter of those in the program — although about 270,000 were added to the rolls in the same period.

State and local officials, policy analysts and advocates for the poor agree that the number of disenrollments was high, but can’t come up with a solid explanation for the cause.

Medicaid officials say the downward trend is probably a sign of an improving economy and a low unemployment rate resulting in fewer people qualifying for coverage.

“There could be other factors, but the strongest proposition is that much of the decrease in enrollment

is due to a strong economy since enrollment has historically been correlated with economic trends,” Medicaid spokesman Tom Betti said.

But that was only conjecture; he could not provide any data to support the assertion.

Franklin County officials said they have no clue why so many have been disenrolled.

“It’s hard to make a guess. It could be the economy,” said Joy Bivens, director of the Franklin County Department of Job and Family Services. “Unless there’s a way to figure out why people aren’t re-enrolling, it’s hard to know.”

Jodi Andes, a spokeswoman for the Franklin County agency, said the reporting system doesn’t provide that level of detail.

“When they leave Medicaid, you can’t see the reason,” she said.

The taxpayer-funded health insurance is available to the poor and disabled.

Beneficiaries can lose their coverage for a number of reasons: they no longer qualify because their income increased; they found another source of health insurance, perhaps through a job; or they failed to submit updated information about their household income as required each year under federal guidelines.

Loren Anthes, public policy analyst for the Center for Community Solutions, noted that Medicaid beneficiaries typically cycle on and off the rolls. On average, people are enrolled for a consecutive nine months at a time.

For example, during the first 10 months of 2018, 704,286 beneficiaries were disenrolled while 272,969 new

members came on to the rolls. The state apparently does not track why people are removed, but Anthes said it’s likely that some removed from the rolls re-enrolled, and are among the new recipients.

It’s not unusual, Anthes said, for someone to drop off the rolls when they find a job, but return after becoming unemployed again. Others may enroll when they have a health issue, then drop when they recover and have no immediate need for coverage.

“Do they come back to fill out redetermination forms? Often they don’t until they need coverage again,” Anthes said. Doctors, hospitals and other health-care providers typically help the uninsured who qualify sign up for Medicaid when they seek treatment.

But Anthes and other advocates say there also may be problems tied to

the state’s computerized enrollment setup, the Ohio Integrated Eligibility System. It’s been handling Medicaid applications and annual redeterminations for several years. But since adding food stamps and cash assistance benefits in August, there have been numerous reports of Ohioans having trouble enrolling or being disenrolled for no apparent reason.

“I think it’s questionable when OIES is having problems with (food stamps) and cash assistance and (officials claim) it’s not causing a problem with Medicaid,” Anthes said.

Betti said he was not aware of any computer glitches causing or contributing to the problem.

“There still are some defects,” but no major problems, said Jeanne Carroll, assistant director of the Ohio Job and Family Services Directors’ Association.

She said the system

automatically disenrolls beneficiaries who fail to submit updated income data for annual redeterminations, although they should get an automated call alerting them to re-enroll if they want to maintain coverage.

Last year, the largest number of disenrollments came in June, when 84,224 were removed from statewide Medicaid rolls, followed by 82,984 in October. The fewest was in February, when 54,328 were disenrolled.

In Franklin County, the largest number of disenrollments came in October when 14,156 were removed, nearly 5 percent of its caseload. The fewest, 3,546, were removed in March.

Dispatch Reporter Rita Price contributed to this report.

ccandisky@dispatch.com @ccandisky