CW: Surgery
Beverly Likens thought she’d done everything she could to keep her Medicaid earlier this year. Then, just before her surgery to treat chronic bleeding, the hospital informed her that her insurance was inactive, putting her procedure in jeopardy.
Likens had been diagnosed with severe anemia and had received a blood transfusion in the emergency room. Likens was “ready to fall to pieces” according to KFF Health News.
Anemia is a decrease in hemoglobin (Hb), hematocrit (HCT), or RBC (red blood cell count). It is a symptom of a more serious medical condition that might be classified as macrocytic, microcytic, or normocytic. Symptoms of anemia are typically nonspecific and include lethargy, weakness, and fatigue.
Before losing her coverage, Likens qualified for Medicaid because she received Supplemental Security Income, a program for people with little to no income or assets who are blind, disabled or over the age of 65. After losing her SSI benefits in the spring due to having too many assets Kentucky’s Medicaid department informed her in April that she would lose her health coverage automatically but that she may reapply.
The state did not determine whether Likens qualified in another way. Even without SSI, her income was insufficient. When she attempted to reapply, she ran into technical difficulties with Kentucky’s enrollment system, which is a widespread issue across the country.
For many Medicaid beneficiaries , the process of assessing all users’ eligibility has been anything but straightforward. Some people are losing coverage without knowing why. Some are struggling to show that they are still eligible. Medicaid beneficiaries and patient advocates say that their state mailed mandatory renewal applications to out-of-date addresses, didn’t translate documents correctly, and miscalculated income.
Medicaid eligibility is difficult to figure out. Someone who qualifies initially for one reason may continue to be eligible even if their life circumstances change, as long as their income remains below a particular threshold. However, income criteria vary by state and even within a single state.
According to KFF’s unraveling tracker, at least 11.1 million people were disenrolled from Medicaid this year as of Monday, while 20.7 million had their coverage renewed. According to data from the Centers for Medicare and Medicaid Services, Medicaid enrollment increased by 22.6 million during the COVID-19 outbreak, when states weren’t permitted to unenroll people.
Certain Medicaid beneficiaries are more likely to have difficulty maintaining enrollment, according to Jennifer Tolbert, associate director of KFF’s Medicaid and uninsured program. They include pregnant women whose eligibility for the program would change after giving birth, along with children who reach the age of eligibility, and those who were getting SSI but aren’t anymore. This is what happened to Likens. According to the Social Security Administration, there were 7.7 million SSI beneficiaries in 2021.
Medicaid is a lifeline for millions of Americans. People may remain uninsured if they lose their coverage. Those without insurance cannot receive immediate medical care. They are unable to afford prescriptions, doctor visits, preventative care, and other vital services. For some, losing insurance is the difference between life and death.
Sources:
Chaparro, Camila M., and Parminder S. Suchdev. ‘Anemia Epidemiology, Pathophysiology, and Etiology in Low- and Middle-Income Countries’. Annals of the New York Academy of Sciences, vol. 1450, no. 1, John Wiley & Sons, Ltd, Aug. 2019, pp. 15–31, https://doi.org10.1111/nyas.14092.
Pradhan, Rachana. “Medicaid’s ‘unwinding’ Can Be Especially Perilous for Disabled People.” KFF Health News, KFF , 28 Nov. 2023, kffhealthnews.org/news/article/health-202-medicaid-unwinding-perilous-for-disabled-people/.
Turner, Jake, et al. “Anemia.” StatPearls, StatPearls Publishing, 8 August 2023.