On March 31st, a pandemic policy that prevented states from kicking people off Medicaid came to an end. Connecticut is now in the middle of an immense undertaking to reevaluate eligibility for broad swaths of enrollees for the first time in three years.
The vast majority of the roughly 274,000 people who went through unwinding in April, May and June are keeping their coverage, but the process has been stressful for individuals with Medicaid, and also for the organizations that serve them.
Community health centers, or CHCs, are playing a critical role. These organizations provide care to anyone, regardless of ability to pay and nearly two out of every three CHC patients have Medicaid.
“It’s a lot of work,” said Suzanne Lagarde, CEO at Fair Haven Community Health Center, the fourth largest in the state.
Every month, CHCs receive lists of patients who are due for eligibility redetermination but are unable to be renewed automatically by the state. That’s when the hard work begins, said Gilda DiScala, senior director of clinical operations at Fair Haven.
Fair Haven sends their patients postcards and text messages alerting them to complete a renewal application before the end of the month. Then, certified application counselors follow up with phone calls to invite people to make an appointment if they need help with their forms.
At Fair Haven, the number of patients in need of direct outreach each month has ranged from 342 to 559.
“It’s just constant every day calls and calls and just bombarding people,” said DiScala. “We brought on and are paying two additional [full-time employees] to do this. It wasn’t going to be possible with just our existing staff.”
In addition to the two staff members working on unwinding full-time, DiScala also has nine people on her team working on applications at least part-time.
DiScala said roughly half of patients complete the applications on their own, while the other half request appointments with a certified application counselor. It can take a counselor up to an hour to go through the application process with an individual and even longer with a family.
“This is just another legacy from COVID. And, we’re doing our best,” said Lagarde. “It’s still quite time intensive.”
Patients can also retroactively qualify for coverage, even if they miss the initial deadline, so Fair Haven continues to reach out to those who have lost Medicaid since April in hopes of connecting them to coverage.
Of the 444 Fair Haven patients who went through unwinding in April, 187 lost coverage at the end of the month. But, between then and mid-July, the counselors were able to reinstate coverage for all but 30.
“What we’re finding is virtually everyone we connect with is eligible,” said Lagarde.
Major improvements but room for more
Community health center leaders applauded the process improvements made by the state since unwinding began, including the significantly reduced wait times for the Access Health CT call center and the expansion of its hours to include Saturdays, in addition to weekdays.
“The systems have matured. They put things in place that have allowed everything to flow a little bit more smoothly,” said Michael Steinmetz, the chief operating officer at Generations Family Health Center, based in the eastern part of the state. “That’s less work that we have to do.”
In the first couple months of unwinding, Generations, like Fair Haven, got slammed with requests for assistance on applications. Certified application counselors worked with nearly double the number of patients they work with in a typical month.
But, Steinmetz said the initial spike has since calmed down. Like Fair Haven, Generations actively reaches out to patients due for renewals every month and, recently, most patients they get in touch with have already submitted their application or at least started the process.
“We’re returning more to what we normally engage with for helping patients with insurance and applications. It’s still a little bit elevated, but not what it was before,” he said.
At Fair Haven, DiScala said unwinding is still a notable strain.
“It’s stressful. I still think that we are doing a lot of extra work for our patients, which we will gladly do,” she said.
DiScala said she wishes that Access Health CT, the organization managing the online portal for completing applications, would give counselors access to the system so they could submit patients’ applications directly.
Right now, if a certified application counselor sits down with a patient whose application can’t be completed online, they have to call Access Health CT to complete the application via phone.
“AHCT must meet strict federal and state standards in protecting the personally identifiable information (PII) used and held by the [Integrated Eligibility System]. The Call Center representatives must properly authenticate callers when working with them to ensure that they are speaking with the consumer or someone authorized to speak on their behalf, that they are working in the correct consumer account and that no improper disclosure of PII occurs,” stated a spokesperson with Access Health CT.
Steinmetz said that while it would be convenient for counselors to be able to submit applications directly, he understands the security concern.
Recently, Access Health CT began sending representatives, known as outreach specialists, to community health centers to process applications on-site. However, those representatives are only available to work with walk-ins. Lagarde said most Fair Haven patients make appointments with application counselors and virtually no one comes in unscheduled, so, thus far, the additional support hasn’t made much of a dent.
The Access Health CT spokesperson said that while the outreach specialists don’t schedule appointments, the CHCs know the dates and times they’ll be there and could relay that information to patients.
DiScala also suggested that community health centers get access to a list of their patients who have already started an application, which could also help to streamline the process.
Department of Social Services deputy commissioner Peter Hadler stated that the agency “understands the value of working with our local partners, such as the community health centers” and “will continue to improve the processes and partnerships.”
“We will always welcome providers to reach out and discuss how they believe we might make further improvements,” stated Hadler.