Editorial: Get the word out on Medicaid changes

Along with putting many of Hawaii’s wage-earners out of work, the COVID-19 pandemic left many individuals and families in need of health insurance. For those with little to no income, the need was filled by Medicaid, a government health insurance program.

During the pandemic, the federal government declared a COVID-19 public health emergency, stepped in with additional funding for the exploding number of Medicaid recipients and required states to keep all who qualified on the rolls for as long as the emergency declaration remained in effect.

The COVID-19 emergency has not officially been declared over, but this week, Congress moved toward passage on an end-of-year spending bill that would put an end to automatic continuous enrollment for Medicaid recipients.

Hawaii’s Med-QUEST administrators, who handle the state’s Medicaid applications and programs, now must step up to be sure that all who continue to need help get it, and that those who fall off Medicaid are connected with other sources of health insurance.

The new rules will require that recipients verify their income, family size and other information to stay enrolled — and that’s fair. To do this, they will need to be in contact with Med-QUEST.

Those who found new jobs and now are above income levels will lose eligibility, as will those who don’t verify.

The federal budget legislation includes money to keep children in low-income households on Medicaid for at least a year, once they’ve enrolled. But ultimately, Medicaid coverage will again depend on routine verifications.

If Medicaid clients are no longer eligible, Med-QUEST must provide information about other sources of health insurance, including employer coverage, the Affordable Care Act (“Obamacare”) or, for youth, the Children’s Health Insurance Program (CHIP).

It’s estimated that thousands of adults in Hawaii could be dropped after the new rules take effect, in April. Med-QUEST must act to ensure that only those who are ineligible are removed, by rolling out an effective communication program that reaches recipients where they are — including remote, rural communities and transient locations.

Multilingual outreach must also be robustly deployed. As experience with outreach for the COVID-19 vaccinations has shown, there is room for improvement in the state’s reach into immigrant communities.

The spending bill requires states to notify enrollees before they are dropped from Medicaid. Hawaii must take this mandate seriously.

So many Hawaii residents have been added to Medicaid since the pandemic began that it’s likely recipients can be found in every corner of the state. Since the beginning of 2020, the number of Hawaii residents on Medicaid has jumped by about 40%. A staggering half of Hawaii’s children and about one-third of the total population are enrolled.

As of August, 435,388 Hawaii adults and children were covered by Medicaid and its CHIP program for youth, according to medicaid.gov.

Careful stewardship of Medicaid funds is the prudent course, and it’s appropriate that the state and feds should now move to phase in eligibility verifications and careful tracking of funds disbursed.

It’s reassuring that the return to stricter Medicaid verification rules is being accompanied by rule changes at the executive level, as the Biden administration has moved to eliminate unnecessary paperwork by applicants and to study roadblocks to receiving benefits that may affect underrepresented groups. For example, one emphasis has been to make qualification for Medicare subsidies more seamless for low-income seniors.

Another good sign: Gov. Josh Green’s “high priority” spending list, which includes $5 million in fiscal year 2024 and $10 million in fiscal year 2025 to increase the reimbursement rate for Medicaid providers, with the goal of expanded access to health care. According to Green, an outlay of $30 million for improved Medicaid access would be reimbursed with $35 million in federal funds.