MARCH 1, 2018
When
Arkansas lawmakers debated in 2016 whether to renew the state’s Medicaid
expansion, many Republican lawmakers were swayed only if some of the 300,000
adults who gained coverage would have to start paying premiums.
This
“skin-in-the-game” provision — endorsed by conservatives in Washington and in
many statehouses — is designed to make Medicaid recipients value their
government health insurance more and lead healthier lives.
It’s
“to encourage more personal responsibility,” Arkansas Gov. Asa Hutchinson told reporters in
2016. “We want to incentivize better, healthy living.”
Yet few
enrollees are paying the $13 monthly premiums, which apply only to Medicaid
recipients whose earnings surpass the poverty level. In 2017, just 20 percent
of the 63,000 Arkansas enrollees paid. Medicaid enrollees in Arkansas don’t
lose coverage for lack of payment.
Arkansas
is not the only state where Medicaid recipients who gained coverage under the
Affordable Care Act disregard the new premiums. Tens of thousands of Medicaid
enrollees in four other states that added premiums during the past four years—
Indiana, Michigan, Iowa and Montana — have also opted not to pay, according to
state records.
Under
the ACA, states received millions of federal dollars to cover everyone with
incomes under 138 percent of the federal poverty level (about $16,700 for an
individual today). Previously, Medicaid mainly covered only low-income
children, disabled adults and parents.
Premiums,
which are routine obligations in private health insurance and Medicare, were
not a part of Medicaid until that expansion in 2014. In these five states,
conservative lawmakers were hesitant to expand the federal-state program unless
they secured fees from nondisabled adults.
Kentucky
has received approval to add premiums in 2018.
“We
believe the premiums are important to prepare these beneficiaries for what
would be required of them if they move up the economic ladder and get coverage
through an employer or the federal marketplace,” said Arkansas Medicaid
spokeswoman Amy Webb. “It’s a small amount, especially considering the benefit
they are receiving. Under an employer or at the marketplace, they would lose
their coverage for failure to pay.”
Advocates
for Medicaid say it is not surprising that significant numbers of Medicaid
enrollees fall behind on their payments.
“Premiums
are a financial barrier for low-income people, even if you are working,” said
Rich Huddleston, executive director of Arkansas Advocates for Children and
Families. Even the state’s $13 monthly premium is burdensome. “Families have to
make tough choices every day about whether they buy food, pay the electric
bill, their rent, or pay premiums.”
Still,
the experience in the five states shows converting conservatives’
“skin-in-the-game” mantra into practice has many administrative challenges.
Michigan
requires Medicaid enrollees with incomes over the poverty level to pay 2 percent of their income in
monthly premiums, though the amount could be decreased if they engage in
so-called healthy behaviors, such as getting a flu shot or trying to quit
smoking.
A survey of enrollees last
year in Michigan found nearly 88 percent said the amount they had to pay was
“fair,” and 72 percent said they agreed that they would “rather take some
responsibility to pay something for their health care than not pay anything.”
But
from January through August last year, fewer than half of Michigan Medicaid
recipients who owed a premium — about 77,000 of 175,000 — paid it.
And
premiums were not the only new obligation that many of these enrollees are
failing to meet. The state’s Medicaid expansion also required them to fill out
a health risk assessment form with their doctor and promise to improve their
health. In return, members could lower their premiums or gain a $50 gift card.
Of the
900,104 beneficiaries who have been enrolled in Medicaid for at least six
months, 19 percent have completed this
chore, according to state records.
For
most enrollees this is voluntary. But enrollees with incomes above 100 percent
of the poverty level could lose Medicaid coverage if they don’t fill out the
form to attest they will try to improve their health. Michigan particularly is
getting tough: Last month it mailed letters to 13,550 beneficiaries informing
them that they failed to meet this requirement and there will be consequences.
They will be moved off Medicaid and will have to choose a private plan on the
Obamacare insurance marketplace or will be automatically enrolled in one in
June.
Dr.
Renuka Tipirneni, a researcher with the University of Michigan Institute for
Healthcare Policy & Innovation, said it’s unclear if these enrollees will
be worse off in the private plans since many will get subsidies to help cover
their premium costs. But they may face a larger cost-sharing portion or have to
change doctors.
She was
surprised by how few people paid their premiums, given the survey findings.
“Many people want to pay and want to say they are contributing, but what is the
reality of their circumstances?” she asked. The lack of a penalty for not
paying, she added, could be a factor.
Michigan
officials last year also sent 68,000 Medicaid enrollees who owed premiums a
notice that they would garnish any state income tax refunds or lottery
winnings. That led about 7,000 recipients to pay. The state last year collected
premium money from 19,400 through their tax refunds and another 59 from their
lottery winnings, according to a state report.
Arkansas
officials also plan to intercept state tax refunds to recoup unpaid premiums,
but not until 2019.
Other
states have mixed records on collecting Medicaid premiums, according to state
reports:
·
In Indiana, about 25,000 Medicaid recipients were kicked off the programfrom the fall of 2015 to October 2017
for failure to pay — or more than 1 in 3 who owed premiums. The payments range
from $1 to $27. Indiana is the only state to lock enrollees out of Medicaid for
six months for failure to pay the premium for two months in a row — and
about 10,000 recipients fell into that category in 2016. Kentucky recently
received federal permission to add a similar lockout provision this year.
·
Iowa disenrolled more than 14,000 Medicaid enrollees from
January 2016 to September 2017 for failure to pay a $10 monthly Medicaid
premium, though they could re-enroll at any time. More than 40,000 Medicaid enrollees with incomes over 50 percent of
the poverty level were subject to a premium in September 2017 and about
three-quarters of them had not paid nor completed a health risk assessment form
that would have waived the fee.
·
Montana’s Medicaid program dropped 2,884 adults with incomes
over the poverty level from coverage in 2017 for failing to pay a premium. The
state charges 2 percent of the enrollee’s monthly income. Montana allows those
dropped to re-enroll at any time without paying.
Phil Galewitz: pgalewitz@kff.org, @philgalewitz
https://khn.org/news/tens-of-thousands-of-medicaid-recipients-skip-paying-new-premiums/?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=61037066&_hsenc=p2ANqtz--sDDujBzjPyByL3N3Ie3HAQX10tLNsuS8-0EhQEXwhIun5ra1V8Npjn191uJgGggwa7rjcXvWqU8TkSo6FCP2_qqvgkw&_hsmi=61037066
No comments:
Post a Comment