Kristin Fortner received the notice in an envelope labeled “important information”. It was informing her that she needed to prove that she and her husband were still eligible for Medicaid. She completed and mailed the paperwork within a week after receiving it this winter.
Therefore, she was confused when she received a phone call about three months later from the Arkansas Department of Human Services informing her that she had to renew the couple’s Medicaid and that their health insurance would expire unless she returned the paperwork.
Fortner promptly resubmitted the same form in person. Unfortunately, Arkansas Medicaid had already cut them off. She realized her insurance was gone in May when trying to get a prescription for Suboxone, the medication that helps her stay off opiates, from a Walgreens near her home in Fayetteville, Arkansas. She found herself suddenly owing $380. Her Medicaid coverage had expired on April 30, according to the pharmacy’s records.
The 33-year-old waitress, who makes $3 an hour plus tips, left the drugstore empty-handed. She is one of roughly four million Americans who have been kicked off Medicaid since the end of a pandemic-era guarantee that those with the safety-net health care would be able to keep it, forcing every state to embark on a monumental task of determining who still belonged on the rolls. The 3.8 million figure is an undercount since it only includes those who have lost coverage in the 38 states that have voluntarily made their data from this sorting process, known as the Medicaid unwinding public.
According to KFF, the majority of those people have been pulled from Medicaid for reasons unrelated to whether they are genuinely eligible for the program. Three-fourths have been eliminated due to bureaucratic reasons. Such “procedural” cutoffs — caused by renewal notices not arriving at the correct addresses, beneficiaries not understanding the notices, or a variety of state agency errors and logjams — were a risk that federal health officials had warned states about for months as they coached states on how best to carry out the unwinding.
Fortner’s experience demonstrates the bureaucratic maze that traps certain people — and the harm done to their well-being. The Arkansas Medicaid agency, one of the first in the country to begin the unwinding, has repeatedly asked that Fortner provide various records. Ryan, her spouse, has stopped attending physical therapy sessions for a herniated disk. Fortner felt like she was going through withdrawal when she skipped Suboxone for two weeks, and she now stretches the supply by breaking the pills in half after paying for a partial order with a medication discount card.
Signs and symptoms of opioid withdrawal include lacrimation (excessive tears) or rhinorrhea, (runny nose) piloerection (goosebumps) myalgia, diarrhea, nausea/vomiting, pupillary dilation, photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning, according to the DSM-5 criteria.
Medicaid is a lifeline for millions of Americans. People may remain uninsured if they lose their coverage. In some cases not having healthcare coverage can even be fatal. Everyone should have access to affordable healthcare.
Chernew, Michael, and Harrison Mintz. ‘Administrative Expenses in the US Health Care System: Why So High?’ JAMA, vol. 326, no. 17, Nov. 2021, pp. 1679–1680, https://doi.org10.1001/jama.2021.17318.
Goldstein , Amy. “Nearly 4 Million in U.S. Cut from Medicaid, Most for Paperwork Reasons.” The Washington Post, 28 July 2023, http://www.washingtonpost.com/health/2023/07/28/medicaid-unwinding-pandemic/.
Shah M, Huecker MR. Opioid Withdrawal. [Updated 2023 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526012/