What to Know
- An estimated 95,000 people in D.C. are at risk of losing their health coverage in the next decade, according to the District’s Department of Health Care Finance.
- Medicaid will face over $1 trillion in cuts over the next decade under President Trump’s new tax law, and adults will need to verify twice a year that they are working 80 hours a month, are in school or are doing community service.
- You might not know it, but you could be at risk of losing your coverage if your health program is part of Medicaid. Millions of Americans might not realize they’re on federally funded Medicaid due to confusing state-branded health programs.
- Most Medicaid beneficiaries receive care through private companies, not their state, adding to the confusion.
- Medicaid recipients have historically underreported their enrollment, suggesting a major awareness gap. Government records showed 78.5 million people were on Medicaid in 2023, but only 62.7 million self-reported they were the same year.
Federal cuts to Medicaid could cost 95,000 D.C. residents their health coverage in the next decade, according to the district’s Department of Health Care Finance. Many may not recognize they’re at risk if they don’t know the bulk of their plan is funded through federal Medicaid funds.
In January, 87% of D.C.’s Medicaid beneficiaries were enrolled in a managed care plan. Private companies often operate managed care plans, and their patients often don’t know they’re a part of government-funded Medicaid. For example, AmeriHealth Caritas, D.C.’s most popular managed care plan serving over 100,000 residents, is operated by AmeriHealth, a subsidiary of Independence Blue Cross.
Across the country, 40 states and D.C. have contracts with managed care organizations to administer their programs. Many patients might now know their plans are actually Medicaid plans and not private.
But these plans will all be subject to parts of the $1 trillion in cuts to federal health care programs over the next 10 years under President Donald Trump’s new tax law, the so-called “One Big Beautiful Bill,” and their recipients will have to meet additional work requirements.
There are about 274,000 Washingtonians enrolled in D.C. Medicaid according to the Department of Health Care Finance.
Adding to the potential for misunderstandings for the 71 million people on Medicaid and the 7 million on the Children’s Health Insurance Program nationally: other states often name their state Medicaid programs that are more consumer-friendly, but can leave many Americans confused about already complicated programs. Examples include HUSKY Health in Connecticut; SoonerCare in Oklahoma; BadgerCare Plus in Wisconsin; Green Mountain Care; and Dr. Dynasaur in Vermont.
It’s almost certainly going to be a huge problem. There’s already some evidence that people who know about these new work requirements don’t realize it will apply to them, anecdotal evidence. ‘Well, I’m not on Medicaid. I’m on BadgerCare or [HUSKY Health] in Connecticut’ or whatever the case may be.
Pamela Herd, professor of social policy at the Ford School of Public Policy at the University of Michigan
The tax bill that was passed by Congress last month and signed by Trump on July 4 is predicted to bump a total of nearly 12 million people off programs such as Medicaid, Obamacare and CHIP across the country.
Medicaid, the joint federal and state program that provides health insurance to low-income people, those with disabilities, pregnant women and seniors, is the largest health program in the U.S. and will be subject to the largest cuts. Most of the changes won’t take effect until 2027, after the midterm elections.
Why do Medicaid-funded programs have so many names?
Herd said one reason states adopted these familiar-feeling names for their Medicaid programs was to ease stigmas associated with being enrolled in federal assistance.
“There is this kind of irony that that very reasonable attempt to kind of reduce stigma and make these programs feel more like a regular health insurance as opposed to a welfare program, has absolutely produced all these kinds of problems that you’re identifying,” Herd said.
Creating unique branded names also helped consumers differentiate between programs in a crowded and often confusing health care ecosystem, according to health policy researcher Colin Planalp.
“If someone in Minnesota moves to Wisconsin, that [Medicaid] program operates under a different name, which helps people to understand that the rules may be different,” Planalp said.
While the unique names may help consumers grasp the differences between state programs, they also sometimes obscure the programs’ connection to federal policy.
Dr. Benjamin Sommers of the Harvard T.H. Chan School of Public Health warned that if patients don’t know that their health insurance is a part of Medicaid, new requirements from Congress’s megabill will be more likely to cost people their coverage.
If patients don’t know that those plans are part of Medicaid, that’s going to make it harder for them to realize that they need to do this new reporting requirements around their work activities.
Dr. Benjamin Sommers, professor of health care economics at the Harvard T.H. Chan School of Public Health
States’ branded names don’t just cause confusion; they may prevent people from realizing they’re at risk of losing coverage.
Historically, people have underreported their enrollment in Medicaid for decades.
Of the U.S. population, 27.8% of people are enrolled in Medicaid. According to researchers, many of them don’t know they are.
According to Medicaid records, about 78.5 million people were enrolled in Medicaid as of December 2023. In contrast, the U.S. Census Bureau estimated that only 62.7 million people had Medicaid coverage at any point in 2023, based on self-reported survey responses in the Current Population Survey. The disparity between the actual number of people enrolled in Medicaid and the number of people who report they are is known to researchers as the “Medicaid Undercount.”
“What that tells us is many people don’t realize that they have Medicaid coverage,” Planalp said.
Adding to the confusion around Medicaid coverage, 75% of Medicaid beneficiaries nationally are enrolled in managed care organizations that have contracts with state governments to oversee care.
Over half of the beneficiaries’ plans are managed by five Fortune 500 companies such as Centene, Elevance Health (formerly known as Anthem in 2022) and UnitedHealth Group. Many customers interact more with these private companies than they do with their state’s relevant agency.
Sommers said patients are often confused about their enrollment in managed care organizations.
“Some people don’t recognize that they have Medicaid and instead report that they have private insurance or they name the insurance company like Blue Cross or United or Aetna, because they have say Medicaid managed care, which is the most common form of coverage for people on Medicaid,” Sommers said.
Managed care organizations are in charge of the majority of Medicaid
For many patients in these programs, they may not even be aware that their insurance is paid for with federal funds. In fact, the federal government pays the bulk of the cost of Medicaid. In 2023, states paid for about 31% of the joint program, while the federal government paid the other 69%.
Cuts to Medicaid will place more of the burden on states to fund these critical programs. Crucially, just because patients might not know they have Medicaid doesn’t mean they’re not using it or don’t need it.
“These folks who are losing Medicaid are most likely going to become uninsured. Most of them do not have a ready alternative for coverage. Some will, but most won’t because this is by definition a low-income population,” Sommers said.
The Republican-led revisions will require adults between the ages of 19 and 64 to verify twice a year that they are working 80 hours a month, are in school or are doing community service.
Republicans say they are working to end waste, fraud and abuse and refocus the program on the pregnant women, children and disabled people it was created to help. Under the Affordable Care Act, 40 states and the District of Columbia expanded Medicaid to cover more low-income adults.
Critics predict the newest changes will target Americans who are eligible but who will struggle with the paperwork needed to prove it.
Sommers has said that there is little excess to cut from Medicaid, an already cost-effective program that pays providers less than Medicare or private insurance.
Ahead of these national changes, some states implemented their own work requirements. Similar work requirements imposed in Arkansas resulted in thousands losing their coverage and haven’t had a significant effect on employment, according to Sommers and other researchers.
More than 95% of the people who were targeted were already working, caring for family and living with a disability that limited their ability to work, they found.
“One way to think about this is it’s like requiring people to file their state taxes twice a year instead of once a year,” Sommers said of the coming national changes.
“It’s a pretty big burden, and if you don’t know the rules or you don’t have the documents to send in, your life is just busy and stressful and you don’t get the mailings, you potentially will lose coverage. And the majority of those folks are likely to become uninsured rather than move on quickly to other insurance.”
This story uses functionality that may not work in our app. Click here to open the story in your web browser.
from Local – NBC4 Washington https://ift.tt/lqbd8M1
0 Comments