Breaking News
December 16, 2017 - Research uncovers mechanism implicated in defective function of tumor-associated dendritic cells
December 16, 2017 - OncoBreak: Stubborn Racial Disparities; Paid Medical Leave & Chemo; DIY Gene Tests
December 16, 2017 - Critical link between obesity and diabetes has been identified
December 16, 2017 - Transfusion dependence reduces access to high-quality end-of-life care for leukemia patients
December 16, 2017 - Porvair and Suzhou Tianlong Bio to develop epigenetic analysis technologies
December 16, 2017 - FDA Approves Ixifi (infliximab-qbtx), a Biosimilar to Remicade
December 16, 2017 - Morning Break: Trump to Get Check-Up; Cancerous Transplant; Death Knell for MIPS?
December 16, 2017 - First transcatheter implant for diastolic heart failure successful
December 16, 2017 - ‘Sushi-like’ nanodiscs provide structural snapshots of misfolding proteins
December 16, 2017 - Inherited gene variation may be to blame for poor survival of patients with early-onset breast cancer
December 16, 2017 - Sign-up deadline is Friday, but some people may get extra time
December 16, 2017 - Higher Booze Taxes Might Pay Off for Public Health
December 16, 2017 - Regular Activity in Midlife Spares Joints in Women
December 16, 2017 - Rain May Not Cause Achy Joints After All: MedlinePlus Health News
December 16, 2017 - MedDiet adherence doesn’t affect acute heart failure mortality
December 16, 2017 - HKBU experts develop new generation of smart anti-cancer drug molecules
December 16, 2017 - Chronic Kidney Disease Audit finds wide variations in coding of CKD patients in primary care
December 16, 2017 - Scientists use nanoparticles to fight Mucoviscidosis
December 16, 2017 - Increasing physical activity decreases risk of death from lymphoma
December 16, 2017 - Fear compromises the health, well-being of immigrant families, survey finds
December 16, 2017 - Rejected antibiotic candidate could be worth a second look, research finds
December 16, 2017 - Is Nation on the Right Track to Combat Opioid Crisis?
December 16, 2017 - Arthritis No Longer Just a Disease of the Old: MedlinePlus Health News
December 16, 2017 - Family members without inherited mutation have increased risk of melanoma
December 16, 2017 - Active surveillance proposed as first-line approach to manage patients with low-risk PMC of the thyroid
December 16, 2017 - Patients’ life values affect their attendance at medical treatment for pelvic-floor dysfunction
December 16, 2017 - Experts consider hazards of antibiotic resistances to be high
December 16, 2017 - Study finds erectile dysfunction as risk factor for early cardiovascular disease
December 16, 2017 - Amber-tinted glasses may reduce insomnia severity
December 16, 2017 - Arthritis Drug Seen Lowering GvHD Risk
December 16, 2017 - Atoh1, a potential Achilles’ heel of Sonic Hedgehog medulloblastoma
December 15, 2017 - Cornell engineers develop new method to measure vital signs using radio waves
December 15, 2017 - Rutgers studies highlight need for salon clients, workers to protect themselves from health risks
December 15, 2017 - FDA Approves Nucala (mepolizumab) for Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
December 15, 2017 - Morning Break: CVS Buying Aetna; Uterus Transplant Baby; Your Brain on Drugs, Redux
December 15, 2017 - Social phobia linked to autism and schizophrenia
December 15, 2017 - Timestrip technology helping to prevent missed vaccinations
December 15, 2017 - Researchers win NIH grants for Alzheimer’s research on Amish resilience and rapid onset
December 15, 2017 - Mitochondrial error-correction mechanism essential for energy production of cells
December 15, 2017 - New report reveals steep rise in lung disease admissions to emergency departments during winter
December 15, 2017 - Study finds social stigma as barrier to successful treatment of children with HIV in Ethiopia
December 15, 2017 - Health Tip: Keep Gift-Giving Stress Under Wraps
December 15, 2017 - Long Stoppage of Bisphosphonates Tied to More Fractures
December 15, 2017 - Triglycerides Test: MedlinePlus Lab Test Information
December 15, 2017 - Study shows interventions, though few, can be effective for students with high-functioning autism
December 15, 2017 - Higher blood sugar during first trimester of pregnancy increases child’s risk of congenital heart defect
December 15, 2017 - Study tests accuracy of laboratory-developed cancer tests and FDA-approved companion diagnostics
December 15, 2017 - Extracellular vesicles can be used to effectively delay progression of kidney damage
December 15, 2017 - Targeted lung cancer treatments may benefit smokers and non-smokers alike
December 15, 2017 - Sugary-drink warning labels may help decrease obesity and overweight prevalence
December 15, 2017 - Coarse particulate matter exposure linked to increased asthma risk in children
December 15, 2017 - OCT Angio Gains Ground: Ophthalmology Times
December 15, 2017 - Flu Can Have Dangerous Domino Effect on Older Adults: MedlinePlus Health News
December 15, 2017 - A daily cup of hot tea may lower glaucoma risk
December 15, 2017 - New blood test accurately forecasts advanced heart failure patients’ survival after surgery
December 15, 2017 - Study finds improvements in survivals rates of individuals with kidney failure
December 15, 2017 - Rare gene mutation gives rise to low sensitivity to pain
December 15, 2017 - Older Women Do Well with New Breast Cancer Drugs
December 15, 2017 - Joint damage in healthy military recruits may mimic spondyloarthropathies
December 15, 2017 - Researchers examine link between tumor mutational burden and response to immune checkpoint therapy
December 15, 2017 - Nanotextured surfaces kill bacteria without harming mammalian cells
December 15, 2017 - Ketamine more effective than common sedative in reducing suicidal thoughts
December 15, 2017 - Scientists engineer light-emitting plant
December 15, 2017 - Medicare fails to recover hundreds of millions of dollars in lab overcharges
December 15, 2017 - IPM begins first clinical trial of vaginal rings to prevent HIV in women
December 15, 2017 - Telemedicine for addiction treatment? Picture remains fuzzy
December 15, 2017 - Genetic variations may help identify people at high-risk for chronic pain after surgery
December 15, 2017 - Intersect ENT Announces FDA Approval of Sinuva (mometasone furoate) Sinus Implant, a New In-Office Treatment Option for Recurrent Nasal Polyps
December 15, 2017 - Learning the Lessons of FluMist
December 15, 2017 - Study shows brain structures make some people resilient to Alzheimer’s disease
December 15, 2017 - UQ researchers create new and improved version of ‘love hormone’
December 15, 2017 - Anti-stress compounds provide new treatment approach for diabetes and obesity
December 15, 2017 - Survey finds extremely high rate of mortality from sepsis in ICUs
December 15, 2017 - Study provides insights into molecular mechanisms regulating cellular fate of SCCs
December 15, 2017 - Researchers identify previously unknown functions of natural killer cells in the womb
December 15, 2017 - Tech at Bedtime May Mean Heavier Kids
December 15, 2017 - Meta-Analysis: Hearing Loss Linked to Dementia in Elderly
December 15, 2017 - Second Phase 3 study results for LMTX published
December 15, 2017 - Researchers team up to identify vulnerabilities of lethal parasite
December 15, 2017 - Experts call for more action on gambling-related research and treatment
Some states roll back ‘retroactive Medicaid,’ a buffer for the poor — and for hospitals

Some states roll back ‘retroactive Medicaid,’ a buffer for the poor — and for hospitals

image_pdfDownload PDFimage_print

If you’re poor, uninsured and fall seriously ill, in most states if you qualify for Medicaid — but weren’t enrolled at the time — the program will pay your medical bills going back three months. It protects hospitals, too, from having to absorb the costs of caring for these patients.

But a growing number of states are rescinding this benefit known as “retroactive eligibility.” On Nov. 1, Iowa joined three states that have eliminated retroactive coverage for some groups of Medicaid patients since the Affordable Care Act passed. Each state had to secure approval by the federal government.

Retroactive eligibility has been a feature of Medicaid for decades, reflecting the program’s emphasis on providing a safety net for poor, disabled and other vulnerable people. In contrast to private insurance, determining Medicaid eligibility can be complex and the application process daunting, advocates say. A patient’s medical condition also may keep families from applying promptly for coverage.

All four states — Arkansas, Indiana and New Hampshire, in addition to Iowa — have expanded Medicaid under the health law, which allowed states to include adults with incomes up to 138 percent of the federal poverty level, or about $16,000 for one person. So, in theory, most adults are required to have insurance under the ACA. In practice, each state still has a significant number of uninsured, ranging from 5 to 8 percent of the population.

The retroactive coverage “can compensate for the sorts of errors and lapses that can so easily occur on the part of both the applicant and the government bureaucracy” that delay applications, said Gordon Bonnyman, staff attorney at the Tennessee Justice Center, a public interest law firm that represents low-income and uninsured residents.

State and federal officials say eliminating the retroactive coverage helps encourage people to sign up for and maintain coverage when they’re healthy rather than waiting until they’re sick to enroll. It also fits into federal officials’ efforts to make Medicaid, the federal-state program that provides health care for low-income adults and children, more like private insurance.

But consumer advocates and health care providers say the shift will saddle patients with hefty medical bills and leave hospitals to absorb more uncompensated care when patients can’t pay. Some worry this could be the start of a trend.

In Iowa, the change applies to just about anyone coming into Medicaid — except for pregnant women and children under age 1. The change will affect up to 40,000 residents annually and save the program more than $36 million a year.

“We’re making it a lot more likely that Medicaid-eligible members are going to incur significant medical debt,” said Mary Nelle Trefz, health policy associate at the Child & Family Policy Center in Des Moines, whose organization opposed the change.

When someone has a traumatic health event, the initial focus is to get them stabilized, not figure out how to pay for it, said MaryBeth Musumeci, associate director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Patients may neglect to apply immediately for Medicaid, leaving them financially responsible for days or months of care they received before they got in their application, even though they may have been eligible for Medicaid all along.

That’s not the only issue, advocates say. Unlike the commercial insurance market where re-enrollment through someone’s employer is routine, Medicaid requires that beneficiaries’ eligibility be reassesed every year.

“People fall through the cracks,” said Andrea Callow, associate director of Medicaid initiatives at Families USA, a consumer advocacy group.

In addition, complications can arise for people who might need Medicaid coverage for long-term care services. “The criteria are complicated. For a layperson to find those criteria and figure out if they’re eligible” is challenging and they may need extra time, said Musumeci. Once patients have secured coverage, they may already have accrued hefty expenses.

Maybe so, but some people argue that a 90-day retroactive eligibility guarantee is counterproductive.

“We’re trying to get people to behave more responsibly, not less responsibly,” said Gail Wilensky, an economist who oversaw the Medicaid and Medicare programs in the early 1990s under President George H.W. Bush. “That is not the signal you’re sending” with three months of retroactive eligibility. A 30-day time frame is more reasonable, Wilensky said.

In contrast to Iowa, the waivers in Arkansas, Indiana and New Hamsphire generally apply only to adults who gained coverage under the law’s Medicaid expansion. (Indiana’s waiver also applies to other groups.)

Kentucky has a request pending that, like Iowa, would eliminate retroactive Medicaid eligibility except for pregnant women and children under 1, according to KFF.

Under federal law, officials can waive some Medicaid coverage rules to give states flexibility to experiment with different approaches to providing services. And retroactive eligibility waivers in Medicaid are hardly new. A few states like Tennessee have had them in place for years. Tennessee officials eliminated retroactive eligibility for all Medicaid beneficiaries in 1994 when the state significantly expanded coverage under TennCare, as Medicaid is known there. At the time, the state even allowed uninsured people to buy into the program who wouldn’t otherwise qualify based on income, said Bonnyman.

“There was no reason for anybody to be uninsured except undocumented immigrants,” said Bonnyman. “It didn’t seem to have the potential for harm.”

But state officials revamped that program after serious financial problems. Eligibility for TennCare has become more restrictive again.

Other states that waived retroactive coverage for at least some Medicaid groups include Delaware, Maryland, Massachusetts and Utah, according to the Kaiser Family Foundation.

Bonnyman said his group frequently works with Medicaid beneficiaries who have medical bills they can’t afford that accumulated during the months before they applied for Medicaid.

“If you’re a moderate- to low-income working family, one or two days in the hospital is enough to ruin you financially,” he said.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.


Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles