North Carolinians face a significant challenge as the federal provision preventing states from removing Medicaid participants from their coverage in the first three years of the pandemic has expired.
The change has put thousands of residents at risk of losing their health coverage in the coming year through a process called redetermination.
Rebekah Garcia, supervising attorney for Legal Aid of North Carolina, expects 300,000 people to be ineligible for Medicaid. She also noted some people may lose coverage if they fail to respond to requests for information regarding their eligibility.
"One of our largest concerns at Legal Aid of North Carolina is that individuals who are still eligible are going to be disenrolled or terminated simply because of an administrative reason," Garcia emphasized. "Having the wrong, address with DSS, so they're not receiving those notices."
In order to avoid any issues, Garcia advised individuals to check with the Department of Social Services and ensure their contact information is kept up to date for receiving notifications. She added it is important to note if you do happen to lose coverage, there are options available. You can either contact Social Services within 90 days with the required information, or take advantage of a special enrollment period open until next May 24, and sign up for a qualified plan.
Another important issue they face is the possible loss of coverage for many children if notices are not interpreted correctly. Garcia pointed out eligibility requirements have multiple categories which may qualify children for assistance even if their parents do not.
"The income limits are very low, about 45% of the federal poverty level in order to qualify, whereas the income levels for children are much higher," Garcia explained. "It's at about 211% of the federal poverty level."
Garcia added they understand the process could get confusing, so Legal Aid of North Carolina, along with Charlotte Center for Legal Advocacy and Pisgah Legal Services, has created NCMedHelp.org, a website to serve as a vital resource for beneficiaries seeking advice on Medicaid eligibility and next steps.
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Until the pandemic, telehealth and telemedicine were still outliers in health care but they have gone mainstream, especially benefiting underserved and rural New Mexico communities.
Heather Dimeris, director of the Office for the Advancement of Telehealth at the Health Resources and Services Administration, the primary federal agency tasked with improving access to health care services for people who are uninsured, isolated or medically vulnerable, said a national conference being held today will bring public- and private-sector leaders together to discuss topics related to best practices.
"Telehealth licensure, agreements between states to help practitioners practice across state lines, as well as access to broadband," Dimeris outlined. "This is free and virtual and it's open for the public."
Dimeris explained government data show patients who get telehealth services have the same, and in some cases better, outcomes as in-person visits.
Dimeris noted underserved communities often see benefits and improvements in their quality of life through behavioral-health services via telehealth. And those who qualify can leverage the federal Lifeline program, a free government phone service through the Federal Communications Commission.
"Internet is really a foundation of good telehealth services and we can do audio-only appointments, or appointments over the phone, but it's always nice to at least have the video chat," Dimeris pointed out. "That connectivity can be really hard in remote areas of New Mexico."
She added expanding virtual visits could cut down lengthy waitlists for urgent appointments. And she acknowledged many people seeking mental health services prefer to talk with a doctor in order to bypass stigma sometimes experienced with office visits in small communities.
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A new analysis from Washington state shows passing an initiative making a long-term care benefit program optional could cost taxpayers millions.
Initiative 2124 would make optional the WA Cares program, in which workers contribute a little more than 0.5% of their paychecks for access to long-term care benefits. The Office of Financial Management estimates passage of the initiative would cost the state between $12 million and $31 million within three years.
Kristin Hyde, press secretary for the group No on 2124, said other analyses have found even greater consequences.
"This initiative would effectively actually end the program, it would shutter it, it would bankrupt the program," Hyde contended. "By 2027, in effect benefits would not be able to be paid out for the nearly 4 million workers who have been vesting in the program."
Supporters of the initiative, including Rep. Jim Walsh, R-Aberdeen, said the program provides little practical effect and people should have choice on whether to contribute to the program. Under the program, Washingtonians will have access to up to $36,500 in benefits from the WA Cares Fund starting in 2026.
Hyde noted the program can be used to pay home aides, for instance, which could help more than 800,000 family caregivers in the state. She added many caregivers are women who sometimes have to choose between work and taking care of family members.
"Long-term care is not covered by regular health insurance and it's also not covered by Medicare," Hyde pointed out. "It's this gap and so we're really in a rock and a hard place here. We don't have anywhere to turn."
Hyde explained it is why state lawmakers approved the WA Cares Fund. She stressed the benefits are flexible and available for use on expenses like home modifications as well.
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Kentucky has made some changes to expand access to free transportation for people who need help getting to medical, dental and mental health appointments, picking up prescriptions and more.
Medicaid's nonemergency medical transportation benefit will now include individuals who own a working vehicle but cannot drive due to a medical condition.
Emily Beauregard, executive director of Kentucky Voices for Health, noted it also applies when using the vehicle conflicts with another household member's need to drive to work, school or their own health care appointment.
"It's going to mean that a lot more Medicaid members will be able to schedule these appointments, make it to the doctor, and not have to schedule everything around when a car or a ride is available to them," Beauregard explained.
If the vehicle is unusable or is unsafe, Medicaid members will need a note from a clinician, employer, school, mechanic, or transportation authority stating the vehicle isn't operable. Nearly 60% of Kentucky Medicaid beneficiaries report lack of reliable and affordable transportation as a barrier to receiving health care services, according to data from the University of Kentucky.
Amber Sparks, a Corbin resident, said she relied on nonemergency medical transportation when her son experienced a mental health crisis requiring hospitalization. She recalled not until she needed nonemergency medical transportation did she realize it was available.
"Another instance that I had to deal with it is that my dad was diabetic, and he wasn't homebound, but he did need daily care and daily back-and-forth to appointments," Sparks recounted.
Beauregard outlined how Kentuckians can find out if they quality for transportation assistance.
"They can call the regional broker in their area," Beauregard pointed out. "If they don't have a car in their name -- or if there is a car, but it's in use for work or for school by another adult in the household -- they should be able to get approved for nonemergency medical transportation."
She added rides can be scheduled with those regional brokers by appointment, Monday through Friday, 8 a.m. to 4:30 p.m., or Saturday from 8 a.m. to 1 p.m., at least three business days before their trip. A list of brokers is online at kyloop.org or by calling Kentucky Medicaid at 800-635-2570. For medical emergencies, call 911.
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