Q&A: Thousands of Alaskans on Medicaid could lose coverage in the coming months. Here's what to know. [Anchorage Daily News, Alaska]

Apr. 20--Alaska this month resumed its annual reviews of Medicaid eligibility for the first time since the COVID-19 pandemic began, as part of a return to federal pre-pandemic policies.

Currently, around one in three Alaskans is enrolled in Medicaid, the country's largest public insurance program. Recipients include eligible low-income adults, children, pregnant women, older adults and people with disabilities. States administer the program, which is funded jointly by states and the federal government. Alaska's Medicaid programs are sometimes referred to as DenaliCare and Denali KidCare.

The process could result in thousands of Alaskans being dropped from the program over the next 12 months, though exactly how many isn't yet clear.

We've compiled a guide for Alaskans who are enrolled in the state's Medicaid programs who may be wondering what's changing, how their eligibility will be redetermined by the state, and what to do if they're dropped from the program.

What's changing this month, exactly?

An annual renewal process, which was paused during the pandemic, restarted April 1 following an end to the federal moratorium. To be clear, this doesn't mean that non-eligible Alaskans will suddenly be losing their health insurance in April -- just that state officials will start reviewing Medicaid eligibility again this month.

Officials in Alaska have said they won't know exactly how many people could lose coverage until they look at each case, which will happen gradually over the next 12 months. The earliest any Alaskan on Medicaid could be dropped from the program is June 1.

Under a provision in the federal health emergency that began in March 2020, Alaskans who might otherwise have lost Medicaid coverage due to a new job or other change in status were able to keep their coverage for the last two years without needing to submit annual paperwork -- even if their income rose high enough that they were no longer eligible for the program.

Between April 2019 and December 2022, the number of Alaskans enrolled in Medicaid increased by about 22% to 260,000, part of a national increase in Medicaid enrollees during the pandemic.

In Alaska, the increase has been linked to an historically low uninsured rate in the U.S. and in Alaska -- 12% now in the state, compared to 19% just a few years ago, according to Lori Wing-Heier, director of the Alaska Division of Insurance.

When and how will the state be reviewing Medicaid eligibility?

While the state's Division of Public Assistance is still trying to work through an unprecedented backlog in benefits applications, health officials have said that they have a plan to gradually tackle Medicaid renewals.

Their plan involves dedicating a team of eligibility technicians to the renewal process and slowly increasing the number of renewals they process each month.

That means that each month over the next year, somewhere between 10,000 and 30,000 Alaskans currently enrolled in the program will have their Medicaid eligibility redetermined by the state.

That will happen either automatically or manually via an online state database search that takes into account income and other personal information.

Alaskans whose eligibility cannot be verified with that database search will receive a packet in the mail from the state requesting additional information to help the state confirm their eligibility.

State health officials have said that there's no way to know for sure when exactly someone's application will be reviewed, or whether they're eligible for automatic renewal.

They're urging Alaskans on Medicaid to check their mail regularly for correspondence from the state, and to update their contact information with the state if their address has changed at all in the last three years.

Wing-Heier with the Division of Insurance, said she was hopeful that the impacts of the shift would be minimal.

"Unfortunately, the onus is on the recipient to enroll and if we cannot contact them, or they do not act, they will lose their Medicaid or not be enrolled in the individual market if they no longer qualify for Medicaid," she wrote.

Alaskans can update their contact information online or by calling the state's Medicaid Information Update Hotline, 1-833-441-1870, which is staffed by a team dedicated to process contact information changes and was established to reduce wait times through the virtual call center.

How do I find out if I'm still eligible for Medicaid?

Alaskans whose gross household income is at or below certain percentages of the federal poverty level -- which varies based on household size -- may be eligible for the program. You can use the state's online eligibility screening tool to calculate whether you qualify based on income.

Alaskans with certain disabilities, who are pregnant or who fit a few other extenuating circumstances have distinct eligibility requirements.

If you're having trouble, you can dial 211, or 800-478-2221, or visit 211 s website to ask for a free appointment with a health care navigator who can help you determine whether you're still eligible. Those appointments can happen in person in Anchorage, the Mat-Su, Fairbanks and Soldotna, and virtually for the rest of the state.

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I don't think I'm eligible for Medicaid anymore. What should I do, and how can I prevent a gap in coverage?

Alaskans who believe they may no longer be eligible for Medicaid can still "get their ducks in a row" before they are dropped from the program, said Jane Straight, a health director with the United Way of Anchorage.

That can mean checking with an employer to see what employer-sponsored health insurance is an affordable option, or what the cost might be for plans through the Affordable Care Act federal marketplace.

Straight said that Alaskans who are worried they may be dropped from Medicaid should reach out to 211 and its health care navigators as soon as possible to help them explore what their options are.

Alaskans without job-based health insurance programs -- or who have options through their employer that aren't affordable -- are eligible for tax credits through the federal marketplace. A navigator can help them weigh their options.

"I think we're kind of concerned that people will think that they don't have another option (besides Medicaid)," Straight said. "Our mantra always is, it doesn't cost anything to check it out. You might be surprised by how affordable it is."

What do I do if I get dropped from the program?

If the state determine that someone is no longer eligible for Medicaid, that person will receive a notice at least 10 days before their coverage will end informing them of the state's decision, according to Deb Etheridge, director of the Alaska Division of Public Assistance.

If affordable workplace coverage is available to someone, losing Medicaid coverage entitles Alaskans to a special enrollment period of 60 days, Straight said.

If someone loses Medicaid coverage and needs to get coverage through the health insurance marketplace, from now through July 31, 2024, they'll be able to apply for a marketplace plan anytime after their Medicaid coverage ends. Applicants will have 60 days after submitting their application to enroll in a marketplace plan, which begins at the start of the following month after enrollment is complete.

Most marketplace plans begin the 1st of the next month, so signing up within a few days of receiving the notice of Medicaid ineligibility is the best way to avoid a gap in coverage.

Health care navigators can help people in this situation, too, Straight said.

What if I think the state made a mistake?

Alaskans who think they're eligible for Medicaid but are dropped anyway have the right to a fair hearing, which is a review of a decision made by the state. Information about requesting a fair hearing will be sent to those who lose coverage, and information about the process is available online.

Fair hearing requests can be made in person, by phone or in writing to any employee of the Alaska Division of Public Assistance, and must be made within 30 days from the date of the notice, health department spokeswoman Sonya Senkowsky said in an email.

Alaskans are also able to seek legal help with the fair hearing process by reaching out to Alaska Legal Services, a nonprofit that provides free assistance to low-income Alaskans in need. The intake number is 1-888-478-2572, or applications for assistance can be filled out online.

It sounds like the division will be really busy with all these renewals and the backlog. Will this impact how quickly they're able to process new Medicaid applications?

The state says it has a goal of processing new Medicaid applications within 45 days, which is a federal requirement, according to health department spokeswoman Shirley Young.

In recent months, the state has fallen short of meeting that timeline.

The state Division of Public Assistance is still trying to work through a backlog of public assistance applications, including around 18,000 Medicaid applications filed this fall and winter -- a number that the state says is not entirely accurate since it includes duplicate applications, though it still reflects continued delays.

Those delays have resulted in Alaskans waiting six months or more for their applications to be processed, and have triggered a lawsuit and a sharp federal warning.

In order to make it feasible do all three things at once -- work through the benefits backlog, complete Medicaid renewals and handle new applications -- the state has said it has a plan that involves hiring more staff and dedicating a separate team of workers to each task.

"We have tremendous support from the governor and the commissioner's office," Etheridge said. "We're bringing on new staff as fast as we can. And we have a plan."

Resources

--To reach an eligibility technician with the state to check on the status of an application or with other questions, the Virtual Call Center number is 1-800-478-7778. Wait times have been lengthy amid the backlog, but callers have the option to leave their number for a same-day callback.

--To update your contact information with the state, you can visit their online form or call the Medicaid Information Update Hotline, 1-833-441-1870, which is staffed by a team dedicated to process contact information changes and was established to reduce wait times through the virtual call center.

--For a free appointment with a health care navigator who can help you determine if you're still eligible for Medicaid -- and what your options are if you're not -- dial 211, or 800-478-2221, or visit the Alaska 211 website. Those appointments can happen in person in Anchorage, the Mat-Su, Fairbanks and Soldotna, and virtually for the rest of the state.

--To check your eligibility for Medicaid, visit state's online eligibility screening tool: https://aries.alaska.gov/screener.

--Alaskans who think they're eligible for Medicaid but are dropped anyway have the right to a fair hearing, which is a review of a decision made by the state. Fair hearing requests can be made in person, by phone or in writing to any employee of the Alaska Division of Public Assistance, and must be made within 30 days from the date of the notice.

Correction: This story has been updated to remove an incorrect phone number and incorrect links for finding more information about requesting a fair hearing on Medicaid eligibility determinations, and information from Alaska Legal Services has been added to this article.

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