KALISPELL, Mont. 鈥 On a cold February morning at the , Tashya Evans waited for help with her Medicaid application as others at the shelter got ready for the day in this northwestern Montana city.
Evans said she lost Medicaid coverage in September because she hadn鈥檛 received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.
鈥淭he teeth broke off. My gums hurt. There鈥檚 some times where I鈥檓 not feeling good, I don鈥檛 want to eat,鈥 she said.
Evans is one of about who have lost Medicaid coverage as the state reevaluates everyone鈥檚 eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That鈥檚 one of the in the nation, according to a 素人色情片analysis.
Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.
As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from , which serves much of the homeless population here, and recounted her struggle to reenroll.
She said that she had asked for help at the state public assistance office, but that the staff didn鈥檛 have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state鈥檚 help line, but couldn鈥檛 get through.
鈥淵ou just get to the point where you鈥檙e like, 鈥業鈥檓 frustrated right now. I just have other things that are more important, and let鈥檚 not deal with it,鈥欌 she said.
Evans has a job and spends her free time finding a place to sleep since she doesn鈥檛 have housing. Waiting on the phone most of the day isn鈥檛 feasible.
There鈥檚 no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it鈥檚 a big problem.
Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said , a case manager at HRDC, a homeless shelter in Bozeman.
鈥淲e鈥檙e getting mail that鈥檚 like, 鈥極h, this needs to be turned in by this date,鈥 and that鈥檚 already two weeks past. So, now we have to start the process all over again,鈥 she said. 鈥淣ow, they have to wait two to three months without insurance.鈥
Montana health officials told NPR and 素人色情片Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.
and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don鈥檛 reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn鈥檛 taken that step.
Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers . Redetermination ended in January, four months ahead of the federal deadline.
鈥淚鈥檓 confident in our redetermination process,鈥 Brereton told lawmakers in December. 鈥淚 do believe that many of the Medicaid members who鈥檝e been disenrolled were disenrolled correctly.
Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it鈥檚 easy for them to fall through the cracks.
, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, 鈥減ut yourself in the position of an elder experiencing homelessness,鈥 especially those without access to a computer, phone, or car.
If they still qualify, people can usually get their Medicaid coverage renewed 鈥 eventually 鈥 and it may reimburse patients retroactively for care received while they were unenrolled.
Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have .
鈥淏eing out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,鈥 she said.
When people don鈥檛 understand why they鈥檙e losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.
Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.
Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.
鈥淗e waited all day long. By the fifth time, it was so stressful for him, he just gave up,鈥 she said.
That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.
Baker worries his poor health will catch up with him before he decides to try again.
This article is from a partnership that includes , , and 素人色情片Health News.
