Will benefits end this year?
When the public health emergency is over, recipients could be without health insurance
Before Angela Bond Cromer started to receive Medicaid benefits three months ago, she relied on help from Casa Guadalupe Center to make sure there wasn’t a lapse in her medicine when she couldn’t afford the copay on a prescription.
Bond Cromer, 59, takes medication daily to treat a mental health condition and before Medicaid, the copay was $72 a month, which for her was expensive. Bond Cromer’s husband died last year and her only source of income is Social Security disability insurance, she said. The copay and the rent she pays for a single room at a shared living facility in Allentown would leave her with just $15.98 left each month.
“I’m on the razor’s edge,” Bond Cromer said. “I can’t even afford to get a one-bedroom apartment. I have no privacy but it’s still better off for me that I don’t have to worry about my medication.” Bond Cromer is one of the millions of Americans who have ended up on Medicaid over the course of the pandemic. Due to her low fixed-income, Bond Cromer is likely not at risk of losing her Medicaid benefits anytime time soon. But the same can’t be said for many others who are only still receiving benefits because a federal public health emergency declaration has been in effect for much of the pandemic. During this public health emergency, Medicaid recipients haven’t had to recertify, a practice that occurs yearly to determine whether participants still qualify for the
“I can’t even afford to get a one-bedroom apartment. I have no privacy, but it’s still better off for me that I don’t have to worry about my medication.” — Angela Bond Cromer
program, and weren’t at risk of being removed from the program.
The public health emergency has been extended several times, most recently through April 16. The Pennsylvania Department of Human Services expects it will be extended at least once more. But it is expected to end at some point in 2022 and once it does, the Medicaid benefits for many will be on the chopping block.
Some estimates suggest that nearly 15 million people could be kicked off the program nationally. The Pennsylvania Department of Human Services estimates that about 500,000 recipients would be ineligible for Medicaid benefits once the public health emergency is over.
Participation in Medicaid has grown substantially over the course of the pandemic on both a national and local level. This has occurred for a variety of reasons, but a leading one is the loss of employer-provided insurance, something millions had experienced by the end of 2020. Though the lockdowns that affected many businesses and workers are over, growth in Medicaid has been steady throughout the entire pandemic.
The percentage of Medicaid recipients in Pennsylvania grew substantially over the course of the pandemic from about 22% in March 2020 to about 27% as of Jan. 2022. Northampton and Lehigh counties saw similar rates of growth but the actual percentage of residents on Medicaid differed significantly between the two.
A substantial amount of Lehigh County residents, 30%, were on Medicaid at the start of 2022. But Medicaid participation was high in Lehigh County even before the pandemic with nearly a fourth of all residents on Medicaid in March 2020.
Participation is much lower in Northampton County; about 17% of residents were on Medicaid at the start of the pandemic and as of January, it was 21%.
In total Medicaid participation in the Lehigh Valley saw net growth of more than 35,000 residents to 189,176 total.
Hasshan Batts, director of Promise Neighborhoods of the Lehigh Valley, said one of the top concerns the organization has heard from community members the lpast few months is about losing Medicaid benefits and what they can do if that happens.
Jeanie Garcia, an Allentown activist and program manager for Zero Youth Violence and reentry with Promise Neighborhoods of the Lehigh Valley, said she works with many people who receive Medicaid benefits. For many, Medicaid was the first time they had and used quality health insurance and there is a concern about the loss of benefits affecting their continued ability to access health care.
“Some of them were denied Medicaid prior to COVID,” Garcia said. “Then COVID came and they were approved — they got treatments done, they were able to see a doctor and have access to health care and now that’s going to be taken away. If they lose their Medicaid, it’s now back to square one — treatments may not be able to be completed, wellness checkups may not be able to happen.”
Recertification
Inez Titus, deputy secretary of the office of income maintenance for the Pennsylvania Department of Human Services, said in preparation of the PHE ending, the department has taken steps to make the recertification process easier for both applicants and the department
Titus said though recertification isn’t required while the PHE is in place, the DHS still sent Medicaid recertification packets to recipients. Those who filed paperwork that showed they no longer qualified for Medicaid or who didn’t turn in the recertification paperwork didn’t lose their insurance because of the public health emergency but the process has helped them keep track of recipients and prepare for the coming recertification process.
She added even though it wasn’t required many recipients chose to submit recertification paperwork, with those who were recipients before the pandemic and those who became recipients during the pandemic recertifying on a comparable level.
DHS caseworkers already dealt with large workloads before the pandemic but hundreds of thousands of people became Medicaid recipients in Pennsylvania during the pandemic. Chad Meyerhoefer, a Lehigh University economics professor, said a rush of recertification paperwork flowing in once the PHE is over could lead to unnecessary clerical errors that affect people’s coverage.
Titus said DHS is aware this certification process will require extra hands and is working to hire caseworkers for the large amount of expected recertification filings. To avoid certain areas becoming more burdened than others, DHS is also allowing caseworkers from across the state to work on cases outside of their area.
DHS has also taken steps to make it easier for those who will no longer qualify for Medicaid to retain some form of insurance and prevent lapses in coverage. Children who no longer qualify for Medicaid will have their cases transferred by DHS to CHIP, the Pennsylvania children’s health insurance program, to avoid any lapse of coverage.
To help adults, DHS is collaborating with Pennie, Pennsylvania’s health insurance market, on a process that is aimed at preventing coverage lapses. Through this process, Medicaid recipients who no longer qualify for the program will have their application and information sent to Pennie by the DHS. From there, Pennie will figure out what plans those individuals qualify for and inform them of the plans and what they have to do to finish the application process.
“At the end of the day, the Commonwealth as a whole wants to ensure that people maintain coverage and that they’re aware of the options that are out there,” Titus said.
Pennie is working to make sure they can reach everyone DHS forwards to them. Zach Sherman, executive director of Pennie, said all communications from Pennie will be in English or Spanish. For those who speak other languages, Pennie’s call center has a line with translators who cover 100 different languages.
Pennie also recently added having an annual household income equal to or below 150% of the federal poverty level as a qualifying life event to enroll for health insurance through the state program outside of normal enrollment periods.
At present most of the plans available through Pennie are very inexpensive, a single person with a yearly pre-tax income of $19,320 could qualify for an Affordable Care Act benchmark silver plan with little to no premiums as well as low deductibles and copays, according to the Kaiser Family Foundation.
The plans are only as inexpensive as they are thanks to the marketplace subsidies put in place through the American Rescue Plan and these subsidies sunset at the end of 2022. Once they expire, premiums on the same benchmark silver plan for the same household would jump to over $65 per month, according to KFF. Lower premium bronze plans would still be available to many but with the downside of deductibles averaging about $7,000.
Medicaid and Pennie make eligibility determinations based on income but don’t factor in costs of living.Garcia said this will be a problem for many Allentown families. She said the cost of rent in Allentown has increased for many during the pandemic and gas prices have skyrocketed but these won’t be factored into eligibility determinations.
Many of her clients couldn’t afford the premiums on decent Pennie plans before the pandemic so they went without insurance and it’s likely if they lose their Medicaid benefits they will be uninsured again.
“It’s either you pay for health insurance, or you pay to keep the lights,” Garcia said.
Having no health insurance in a post-COVID-19 world could be even worse than it was prior — federal funds that helped pay for uninsured people to get tested and treated for COVID-19 as well as vaccinated are drying up. Due to a lack of funds the U.S. Health Resources & Services has stopped accepting claims for the Uninsured Program and Coverage Assistance Fund. Last month, President Joe Biden’s administration announced that it wouldn’t be able to pay for a fourth dose of the COVID-19 vaccine for every American.
U.S. Rep Susan Wild said she wants to see the federal marketplace subsidies continued.
“We’re working really hard to get those subsidies continued,” Wild said. “I’ve heard from a lot of constituents, who, for the first time, have been able to afford a decent health insurance plan. And by decent, I mean, not just one with a gigantic deductible that they can never use, but actually a real, real plan.”