He’s no longer eligible for NC Medicaid — by $7. Will he get life-saving heart care? [The Charlotte Observer]

Anthony Brooks is one of thousands of North Carolinians on Medicaid set to lose health insurance with the end of a federal pandemic-relief rule, with many more at risk.

The 58-year-old Washington, North Carolina, resident says his loss of insurance could be deadly. He suffers from heart failure and won’t be able to get needed care without finding a way to pay.

During the COVID-19 pandemic, states which accepted increased amounts of federal matching funds for Medicaid service costs could not kick people off of Medicaid, a federal-state insurance program that covers certain low-income and needy individuals.

Typically, states are federally required to renew everyone’s enrollment in Medicaid once or twice a year.

Once this non-withdrawal requirement expired, starting April 1, the N.C. Department of Health and Human Services began the yearlong process of reviewing the eligibility of the over 2.9 million beneficiaries on Medicaid.

As of July 31, there have been 330,591 renewals completed. Those renewals resulted in over 20% of people of people reviewed, or 68,399, losing their coverage. If this pace were to continue, almost 600,000 people could lose coverage, more than the 300,000 estimated by DHHS.

Of those who have lost coverage, data shows that the majority, or over 87%, lost their coverage due to “procedural reasons,” while the remaining 8,637 were deemed ineligible.

A procedural reason, according to DHHS, is a situation in which a caseworker could not get necessary information to confirm someone’s eligibility due to a lack of response or an inability to reach them via phone, text, address or other communication methods. The vast majority of renewals done by DHHS were completed without any information needed from the beneficiary, according to DHHS.

DHHS told The News & Observer that it, alongside local social services agencies, have made many efforts to contact people enrolled in Medicaid to get their information. After a person is removed for procedural reasons, local health organizations and partners in the state reach out once more, DHHS said.

Before the renewal process began, the agency told The N&O it was also informing people about other health insurance coverage options, such as the federal Health Insurance Marketplace.

People who lose coverage due to making too much money could become eligible for federal marketplace aid. Still, many who lose coverage may still make too little to receive subsidies. Making too much for Medicaid but too little to get subsidies is what is often dubbed the “coverage gap.”

After years of stalemate between Democrats and Republicans, the state passed Medicaid expansion into law in late June. But enactment of the expanded parameters has been delayed as Republicans tied the bill to the state budget, which means if the budget does not pass, neither does expansion.

Under those parameters, health insurance coverage under Medicaid would increase to all adults with income below 138% of the federal poverty level, opening the door for hundreds of thousands of North Carolinians to gain eligibility. Many of those who gain eligibility would include people who were removed under the required federal unwinding.

‘I’m $7 from keeping my Medicaid’

Brooks is one of the 8,637 who lost coverage due to eligibility issues.

Last year, Brooks was at work when his face swelled up. He took some medicine and took the next day off of his job as a certified nurse assistant in case the inflammation was due to stress or food poisoning.

But it didn’t get better, and on April 14 he landed in the emergency room.

After hours of waiting, doctors told him he had had a “silent” heart attack. His heart failure is caused by atrial fibrillation, which causes an irregular and often fast heartbeat and can lead to blood clots and more.

Because of this, he can no longer work and lost his health insurance, which he had obtained through the federal marketplace. Now he is on disability benefits, through which he gets just over $1,200 a month. Qualifying for disability allowed him to get on Medicaid.

In North Carolina, the income limit eligibility under Medicaid for a parent or caretaker is currently 41% of the federal poverty level. Adults without children, save for those with disabilities or other qualifying exceptions, have no coverage.

The monthly income limit this year for a single person to qualify for Medicaid for the blind and disabled is $1,215, or 100% of the federal poverty level.

Brooks said in April of this year, he got the renewal notice and shortly afterward was denied eligibility for being $7 over the income threshold. Now he is set to lose his coverage as soon as the end of August, unless an appeal he has filed is approved, he said.

DHHS told The N&O in an email that since June 1, at least 18,000 people have lost health care coverage who likely would have been able to keep it under Medicaid expansion, and an estimated 9,000 people will continue losing coverage each month. They wrote that of the 300,000 they estimate will lose full coverage, a third of those will likely qualify for Medicaid expansion over the next year.

“I’m $7 from keeping my Medicaid, I have heart conditions. And my doctor’s bills are really expensive. My prescriptions are expensive. I mean, I’m used to making $4,000, $5,000 a month. You can imagine what I’m going through. It’s unreal,” Brooks said.

Medicaid expansion delayed

Once Medicaid expansion kick starts, there will be a special enrollment period and individuals who were previously removed can apply for Medicaid at healthcare.gov or epass.nc.gov, or through their local social services agencies, DHHS previously told The N&O.

Top leadership in the House and Senate, which both have a Republican supermajority, have struggled to find a compromise on the budget — which was supposed to pass by June 30 — and have said that one won’t be ready by Sept. 1.

The health and human services department, in an attempt to bypass delays, said in a news release in late July that it had reached an agreement with the federal government to move forward with Medicaid expansion, with an anticipated start date by Oct. 1. But this would require the legislature to pass a budget or separate expansion from it by Sept. 1. Otherwise, the earliest fallback date was Dec. 1 or later, wrote NC DHHS.

“Medicaid expansion will be transformative for access to health care for more than 600,000 North Carolinians, especially those in rural areas, for better mental health and for veterans, working adults and their families,” DHHS told The N&O.

For Brooks, these delays place his life in a tail spin.

If Medicaid expansion had gone live, he would have been able to continue his treatments without stressing and scrambling, he said. He takes medications to regulate his blood pressure, hypertension and cholesterol. Doctors have told him he should get a $180,000 surgery to get a defibrillator in his heart by October.

If he loses his coverage, he said he would be unable to pay for this surgery or for medications and treatment and could die.

He has considered applying for charity care, in which hospitals provide treatment to the uninsured for free or for discounted prices, but he worries he would take on debt that would “ruin” him.

At this point, he plans to wait and see if he can win the appeal.

“I don’t have any other choices. I don’t have any money. I really don’t,” he said.

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