Worse Than People Can Imagine: Medicaid Unwinding Breeds Chaos in States

Published

1 year ago

November 2, 2023

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More than two dozen people lined up outside a state public assistance office in Montana before it opened to ensure they didnt get cut off from Medicaid.

This story also ran on USA Today. It can be republished for free.

Callers in Missouri and Florida reported waiting on hold for more than two hours on hotlines to renew their Medicaid coverage.

The parents of a disabled man in Tennessee who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Childrens Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove theyre still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

Its not just bad, but worse than people can imagine, said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, its anyones guess how many former Medicaid beneficiaries remain uninsured. States dont track what happens to everyone after theyre disenrolled. And the final tallies likely wont be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans insurance status. Email Sign-Up

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Without Medicaid, Patients Miss Appointments

Trish Chastain, 35, of Springfield, Missouri, said her Medicaid coverage is scheduled to expire at the end of the year. Though her children are still covered, she no longer qualifies because her income is too high at $22 an hour. Chastains employer, a rehab center, offers health insurance but her share of the premium would be $260 a month. I cant afford that with my monthly budget, she said.

She said she did not know she might be eligible for a lower-cost plan on the Affordable Care Act marketplace. That still would mean new costs for her, though.

Gaps in coverage can jeopardize peoples access to health services or their financial security if they get medical bills for care they cannot postpone.

Any type of care that’s put off whether it’s asthma, whether it’s autism, whether it’s something as simple as an earache can just get worse if you wait, said Pam Shaw, a pediatrician in Kansas City, Kansas, who chairs the American Academy of Pediatrics state government affairs committee.

Doctors and representatives of community health centers around the country said they have seen an uptick in cancellations and no-shows among patients without coverage including children. Nationwide, states have already disenrolled at least 1.8 million children in the 20 states that provide the data by age. Children typically qualify more easily than adults, so child advocates believe many kids are being wrongly terminated based on their parents being deemed no longer eligible. Meanwhile, enrollment in CHIP, which has higher income eligibility levels than Medicaid, has shown only a tiny increase.

Kids accounted for varying shares of those disenrolled in each state, ranging from 68% in Texas to 16% in Massachusetts, according to KFF. In September, President Joe Bidens administration said most states were conducting eligibility checks incorrectly and inappropriately disenrolling eligible children or household members. It ordered states to reinstate coverage for some 500,000 people.

Varying Timetables, Varying Rates of Disenrollment

Idaho, one of a few states that completed the unwind in six months, said it disenrolled 121,000 people of the 153,000 recipients it reviewed as of September because it suspected they were no longer eligible with the end of the public health emergency. Of those kicked off, about 13,600 signed up for private coverage on the states ACA marketplace, said Pat Kelly, executive director of Your Health Idaho, the states exchange. What happened to the rest, state officials say they dont know.

California, by contrast, started terminating recipients only this summer and is automatically transferring coverage from Medicaid to marketplace plans for those eligible.

The Medicaid disenrollment rates of people reviewed so far vary dramatically by state, largely along a blue-red political divide, from a low of 10% in Illinois to a high of 65% in Texas.

I feel like Illinois is doing everything in their power to ensure that as few people lose coverage as possible, said Paula Campbell of the Illinois Primary Health Care Association, which represents dozens of community health centers.

Nationwide, about 71% of Medicaid enrollees terminated during the unwinding have been cut because of procedural issues, such as not responding to requests for information to verify their eligibility. Its unclear how many are actually still eligible.

State and local Medicaid officials say they have tried contacting enrollees in multiple ways including through letters, phone calls, emails, and texts to check their eligibility. Yet some Medicaid recipients lack consistent addresses or internet service, do not speak English, or are juggling more pressing needs.

The unwinding effort continues to be very challenging and a significant lift for all states, said Kate McEvoy, executive director of the National Association of Medicaid Directors.

People Are Not Getting Through

In many states, that has meant enrollees have faced long waits to get help with renewals. The worst phone waits were in Missouri, according to a KFF Health News review of letters the Centers for Medicare & Medicaid Services sent to states in August. In the letter to Missouris Medicaid program, CMS said it was concerned that the average wait time of 48 minutes and the 44% rate of Missourians abandoning those calls in May was impeding equitable access to assistance and patients ability to maintain coverage.

Some people are waiting on hold more than three hours, said Sunni Johnson, an enrollment worker at Affinia Healthcare, which runs community health centers in the St. Louis area. Thats a significant hurdle for a population in which many have limited cellphone minutes. On May 4, 2023, Jody White (left) and Grace Burke of Morton Comprehensive Health Services in Tulsa, Okahoma, examined a list of the health centers patients whose Medicaid eligibility was up for review that month. White had spent the morning calling patients on the list to make sure they were aware of the process and offer his assistance.(Bram Sable-Smith/KFF Health News)

In Florida, which has removed over 730,000 people from the program since April, enrollees earlier this year were waiting almost 2 hours on a Spanish-language call center, according to a report from UnidosUS, a civil rights advocacy group. The Spanish versions of the Medicaid application, renewal website, and other communications are also confusing, said Jared Nordlund, the Florida director for UnidosUS.

They can barely get the Spanish translations right, he said.

Miguel Nevarez, press secretary for Floridas Department of Children and Families, which is managing the states Medicaid redetermination process, criticized complaints about poor translations and long waits for the Spanish-language call center as a false narrative. He said, The data clearly shows Florida has executed a fair and effective plan for redeterminations.

In California, similarly jammed phone lines, crowded and understaffed county offices, and trouble downloading renewal applications electronically are all compounding peoples difficulty to renew their Medicaid, said Skyler Rosellini, a senior attorney in the Los Angeles office of the National Health Law Program. We do know, based on the cases were getting, that people are not getting through.

Jasmine McClain, a 31-year-old medical assistant, said she tried everything before Montana ended Medicaid coverage for her kids, ages 3 and 5, in early October. She tried submitting paperwork online and over fax to prove they still qualified. She spent hours on hold with the state hotline. After her kids coverage ended, she went to a state public assistance office in Missoula but couldnt get an appointment. One day in mid-October, roughly 30 people lined up outside the office starting as early as 6:40 a.m., before its doors opened.

After three weeks of her pleading for help while her kids were uninsured, the state restored her kids coverage. She said a supervisor told her the familys paperwork submitted online wasnt processed initially.

The phone call system was a mess. Callbacks were a week out to even talk to somebody, McClain said. It just was just a lot of hurdles that I had to get through.

Spokespeople for the Montana, Florida, and Missouri Medicaid programs all said their states had reduced call wait times.

Some Medicaid recipients are seeking help through the courts. In a 2020 class-action lawsuit against Tennessee that seeks to pause the Medicaid eligibility review, parents of recipients describe spending hours on the phone or online with the state Medicaid program, trying to ensure their childrens insurance coverage is not lost.

One of those parents, Donna Guyton, said in a court filing that Tennessees Medicaid program, called TennCare, sent a June letter revoking the coverage of her 37-year-old son, Patrick, who had been eligible for Medicaid because of disabilities since he was 6. As Guyton made calls and filed appeals to protect her sons insurance, he was hospitalized with pneumonia, then spent weeks there before dying in late July.

While Patrick was fighting for his life, TennCare was threatening to take away his health insurance coverage and the services he relied on, she said in a court filing. Though we should have been able to focus on Patricks care, our family was required to navigate a system that kept denying his eligibility and putting his health coverage at risk.

TennCare said in a court filing Patrick Guytons Medicaid coverage was never actually revoked the termination letter was sent to his family because of an error.

Phil Galewitz in Washington, D.C., wrote this article. Daniel Chang in Hollywood, Florida; Katheryn Houghton in Missoula, Montana; Brett Kelman in Nashville, Tennessee; Samantha Liss and Bram Sable-Smith in St. Louis; and Bernard J. Wolfson in Los Angeles contributed to this report. Phil Galewitz: pgalewitz@kff.org, @philgalewitz

Katheryn Houghton: khoughton@kff.org, @K_Hought

Brett Kelman: bkelman@kff.org, @BrettKelman

Samantha Liss: samanthal@kff.org, @samanthann Related Topics California Insurance Medicaid Multimedia States Arkansas California Florida Idaho Illinois Massachusetts Missouri Montana Oklahoma Tennessee Texas Contact Us Submit a Story Tip

Business

Ex-Villa chief Purslow among contenders to chair football watchdog

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2 hours ago

March 1, 2025

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Ex-Villa chief Purslow among contenders to chair football watchdog

A former chief executive of Aston Villa and Liverpool is a surprise contender to become the inaugural chairman of the government’s controversial football watchdog.

Sky News can exclusively reveal that Christian Purslow, who left Villa Park in 2023, is on a three-person shortlist being considered by Whitehall officials to chair the Independent Football Regulator (IFR).

Mr Purslow, an outspoken character who has spent much of his career in sports finance, was this weekend said to be a serious candidate for the job despite having publicly warned about the regulator’s proposed remit and its potential impact on the Premier League.

A former commercial chief at Chelsea Football Club, Mr Purslow spent an eventful 16 months in charge at Anfield, spearheading the sale of Liverpool to its current owners following a bitter fight with former principals Tom Hicks and George Gillett.

He joined Aston Villa in 2018 when the club was in its third consecutive season in the Championship, seeing them promoted via the play-offs at the end of that campaign.

It was unclear this weekend how much of the football pyramid would respond to the appointment of a chairman at the regulator who has been so closely associated with top-flight clubs, given ongoing disagreement between the Premier League and English Football League (EFL) about the future distribution of finances.

One ally of Mr Purslow said, though, that his independence was not in doubt and that his experience of working outside the Premier League would also be valuable if he landed the IFR chairman role.

Another senior football figure said Mr Purslow “would be welcomed by the football community as someone who has worked in football, and not as a civil servant or politician”.

In the past, Mr Purslow has both welcomed the prospect of further regulatory oversight of the sport, while also warning in a BBC interview in 2021, during his stint at Villa Park: “The Premier League has really always been the source of funding for the rest of football and the danger here is killing the golden goose, if we over-regulate a highly successful and commercial operation.

“I think we have to be very careful as we contemplate reform that it does not ultimately damage the game.

“We already have a hugely successful English football Premier League – the most successful in the world.”

Two years later, however, he told Sky News’ political editor, Beth Rigby: “I like the idea that the government wants to be involved in our national sport.

“These [clubs] are hugely important institutions in their communities, economically and socially – so it’s right that they [the government] are interested.”

The disclosure of Mr Purslow’s candidacy means that two of the three shortlisted contenders for what will rank among the most powerful jobs in English football have now been identified by Sky News.

On Friday, it emerged that Sanjay Bhandari, the chairman of Kick It Out, the football anti-racism charity, was also in the frame for the Manchester-based position, which will pay £130,000-a-year.

A decision is expected in the coming weeks, with the third candidate expected to be a woman given the shift in Whitehall to gender-diverse shortlists for public appointments.

The establishment of the regulator, which was originally conceived by the previous Conservative government in the wake of the furore over the failed European Super League project, has triggered deep unrest in the sport.

This week, Steve Parish, the influential chairman of Premier League side Crystal Palace, told a sports industry conference organised by the Financial Times that the watchdog “wants to interfere in all of the things we don’t need them to interfere in and help with none of the things we actually need help with”.

“We have a problem that we’re constantly being told that we’re not a business and [that] we’re part of the fabric of communities,” he is reported to have said.

“At the same time, we’re…being treated to the nth degree like a business.”

Interviews for the chair of the football regulator took place in November, with a previous recruitment process curtailed by the calling of last year’s general election.

Lisa Nandy, the culture secretary, will sign off on the appointment of a preferred candidate, with the chosen individual expected to face a pre-appointment hearing in front of the Commons culture, media and sport select committee.

The Football Governance Bill is proceeding through parliament, with its next stage expected in March.

It forms part of a process that represents the most fundamental shake-up in the oversight of English football in the game’s history.

The establishment of the body comes with the top tier of the professional game wracked by civil war, with Abu Dhabi-owned Manchester City at the centre of a number of legal cases over its financial dealings.

The government has dropped a previous stipulation that the regulator should have regard to British foreign and trade policy when determining the appropriateness of a new club owner.

The IFR will monitor clubs’ adherence to rules requiring them to listen to fans’ views on issues including ticket pricing, while it may also have oversight of the parachute payments made to clubs in the years after their relegation from the Premier League.

The top flight has issued a statement expressing reservations about the regulator’s remit, while the IFR has been broadly welcomed by the English Football League.

A Department for Culture, Media and Sport spokesman said: “We do not comment on speculation.

“No appointment has been made and the recruitment process for [IFR] chair is ongoing.”

Mr Purslow was abroad this weekend and did not respond to a request for comment.

Entertainment

Excitement builds for Oscars – but Hollywood still reeling from wildfires

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3 hours ago

March 1, 2025

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Excitement builds for Oscars - but Hollywood still reeling from wildfires

As Hollywood celebrates the film industry at this weekend’s Academy Awards, not far away from where finishing touches are being put to the red carpet, communities are still coming to terms with the impact of the wildfires which ravaged areas of Los Angeles earlier this year.

Prop master Adam Jette – and his wife and son – lost their home in Altadena.

“Even coming back into the neighbourhood is really, really hard,” he tells Sky News.

“You’re coming back to what it is, which is a disaster site, the whole neighbourhood is gone.”

He says he and others in the same position have no choice but to keep going.

“We all have to keep working in order to support ourselves, in order to have our health insurance, in order to be able to move forward and rebuild.

“And yet the only thing you want to do is just, you know, sit there in misery.”

In Hollywood, few productions have had to be paused because less is being shot here these days, the fires adding to the existential crisis the city was already facing.

Wes Bailey’s company SirReel has been renting out film and TV production equipment in Los Angeles since the 1990s – but in recent years work in the city of dreams has dried up.

First COVID-19, then strikes and now, after a race for scale to commission content for streaming platforms, the industry is facing a production contraction and Bailey says it needs help.

“The fires were, I think, the catalyst to really get people to say ‘we’ve got an emergency here’,” he says.

“You go into the UK and you get a 40% return on your money.

“I think the way that California delivers that incentive has been sloppy, it’s been inconsistent.”

For glossy reality show Selling Sunset, set around high-end real estate in LA, production has now resumed after pausing when the fires broke out.

One of the show’s stars, Jason Oppenheim, says he’s had “many, many” emotional calls from clients.

“I’m 30% therapist right now, 20% attorney, 20% contractor and 30% real estate agent,” he tells Sky News.

He says Los Angeles has issues that need resolving if it wants to continue to attract investment.

“We obviously have a crime problem, we have a homelessness problem, we’ve obviously taxed to the point where we discourage development, and we obviously have seen significant loss of wealthy people leaving the state.

“If you really want to have a healthy, functioning society that’s egalitarian and creates opportunity for everyone, you’re going to need a lot of wealthy people in that city paying taxes, so you cannot force them away and that’s just a fact.”

Yet despite the frustration, he’s optimistic for the future of the Palisades – another area devastated by the fires.

“I would bet anything that the Palisades will be one of the most desirable areas on the planet to live in five years,” he says.

“The houses will be stunning, fireproof, beautiful architecture.”

But that seems a long way off now, and in the meantime for those left with nothing the little they can salvage becomes special.

For Adam Jette that’s even an iron saucepan.

“To be able to pull anything out of this wreckage and have it, it’s so meaningful,” he says.

“It didn’t take our pets and it didn’t take our family, it just took stuff, but even just some of that surviving it really, it means something.”

Buried in the ashes following the wildfires is a lesson in what matters to those who keep this industry going – and it’s not red carpets or golden statuettes.

Entertainment

Brit Awards 2025: Who is performing, who’s nominated and how to watch

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3 hours ago

March 1, 2025

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Brit Awards 2025: Who is performing, who's nominated and how to watch

Tonight’s Brit Awards are shaping up to be a big night for female British artists, including Charli XCX and Dua Lipa.

The ceremony, which is taking place at London’s O2 Arena, will see artists who are currently dominating the charts come together to celebrate the best in popular music.

Leading nominations with five nods is Charli XCX, whose sixth album Brat was a viral hit last year.

Dua Lipa closely follows with four nominations – along with 2024 rising star winners The Last Dinner Party, and 2023 Mercury Prize winners Ezra Collective.

Here is everything you can expect from the biggest night in British music.

What will happen?

Comedian Jack Whitehall is returning to host this year’s ceremony.

It will be his first time at the helm in four years, but fifth in total, after taking on the role for four consecutive years from 2018 to 2021.

There are 16 categories for awards this year, including the big one – album of the year.

In the running for this is Charli XCX – BRAT, The Cure – Songs Of A Lost World, Dua Lipa – Radical Optimism, Ezra Collective – Dance, No One’s Watching and The Last Dinner Party – Prelude to Ecstasy.

Other awards up for grabs include: Artist of the year, group of the year, best new artist, song of the year, international artist of the year, international group of the year, international song of the year, alternative rock act, hip-hop/grime/rap act, dance act, pop act and R&B act.

Last year’s ceremony saw singer-songwriter Raye dominating, with a record number of six wins including a clean sweep of the big three; best artist, best song and best album.

This year, the trophy that winners will pick up on the night has been designed by artist Gabriel Moses.

Who is nominated?

Before the awards have even begun, Charli XCX has been announced as the winner of this year’s songwriter of the year award.

Also recognised is her longtime collaborator AG Cook, winning Brits producer of the year, reflecting the combined impact he and Charli XCX have had on music over the last 12 months.

The singer – whose real name is Charlotte Aitchison – could still pick up another five awards tonight including: pop act, dance act, song of the year, artist of the year and album of the year.

Behind Charli XCX, this year also sees The Beatles pick up a nomination for the song Now And Then.

The song, which was finished by Sir Paul McCartney and Sir Ringo Starr with the help of audio restoration and released in November, is the band’s first nomination since 1977.

The Cure are also back with three nominations – following the release of their 14th album, Songs Of A Lost World, in 2024.

International artists such as Beyonce, Billie Eilish, Taylor Swift, Benson Boone, Chappell Roan and Kendrick Lamar have also all got nods, as well as homegrown talent such as Central Cee, Fred again.., Sam Fender and former Little Mix star JADE.

Sabrina Carpenter will become the first international artist to receive the global success award after breaking records in the UK charts.

The pop star held the top spot on the Official UK Charts for a combined 21 weeks in 2024, the first artist to do so in 71 years.

Her mega-hits Taste, Please Please Please and Espresso held the top three spots simultaneously, making her the first female artist to do so.

Already named as this year’s rising star is British singer-songwriter Myles Smith, whose single Stargazing became one of the UK’s biggest hits of 2024.

You can read the full list of nominations ahead of tonight, right here.

Who is performing?

Taking to the stage at this year’s ceremony is a mix of UK and US artists including Sam Fender, JADE, Teddy Swims and Myles Smith.

Off the back of winning the award for global success, Sabrina Carpenter, will also treat audiences to a performance.

It comes after Carpenter’s slapstick comedy mashup performance at the Grammy’s was dubbed “iconic” by fans.

It is the first year American artists Shaboozey, known for A Bar Song (Tipsy) and Teddy Swims, known for Lose Control, will also perform at the awards.

“I’m beyond grateful and humbled to not only be nominated for a Brit Award but to take the stage,” Shaboozey said.

“This past year has been huge for me with my records getting love from all over the world and now I can celebrate with my friends and fans in London.”

Meanwhile, JADE, whose real name is Jade Thirlwall, said she “manifested” performing at the Brits every day since the release of her debut solo single Angel Of My Dreams last year.

The singer already has three Brit Awards to her name, winning best British single for Shout Out To My Ex, video of the year for Woman Like Me and best British group with Little Mix, but is nominated this year as a solo artist in the song of the year and pop act categories.

Also performing on the night are Lola Young – who is nominated for best pop act – and The Last Dinner Party, who won the Brits rising star award last year.

How to watch

Live coverage of the Brits will start on ITV and ITVX from 8.15pm tonight.

You can also follow along with all the latest from the red carpet and ceremony on Sky News and our dedicated live blog.

For those outside the UK, the show is available to watch internationally on the Brits YouTube channel.