Collective Pressure Gets $6k Medical Bill Cancelled for Central-Appalachia Leader
On Thursday March 23rd, Put People First! PA held a call in day for Central-Appalachia Healthcare Rights Committee member Lauren to demand UPMC cover an in-network vision-saving eye surgery. Despite the surgery being medically necessary, Lauren was left shouldering a crushing $6,018.00 bill. Dozens of PPF-PA members called UPMC on Thursday demanding the cancellation of this charge and sharing the message, “While your company is posting record profits, I think it is shameful that UPMC is making someone pay over $6,000 for something that should be covered by their policy.”
Over the course of the day, PPF-PA members shared their call in experiences with one another and strategized on how to keep pressure on. By 5:00 pm Lauren was informed her bill was wiped clean! Lauren shared:
“Thank you to everyone that participated in the call in day yesterday! I’m so excited to share that thanks to our collective effort my $6,018 bill was wiped and I no longer owe for what was a needed surgery! I am so grateful to be a part of such a powerful organization that’s fighting for all of us to have access to quality healthcare that won’t drain us financially! It makes me sick to think of how many other people have been in my situation and have had to try and pay back astronomical bills that they should have never been responsible for in the first place!
“Personally, I found it very powerful how we stayed in communication all day via text with people reporting back what they learned or what future callers may need to know in order to get the answers we wanted. It really highlighted how we worked as a collective to give real time updates as things developed.
“This whole experience really hammers home how badly we need a Public Healthcare Advocate in PA! It is so crucial to have someone that can hold these insurance corporations accountable and to a higher standard so that no one has to panic about how they will afford to pay for treatment or preventative care! I am so humbled and thankful for everyone in this organization and am awestruck by how powerful we are as a collective! It truly is forward together!!”
Starting on April 1st, Health and Human Services Departments in states across the U.S. will begin issuing letters cutting 18 million people from Medicaid. More than 1,200,000 people in Pennsylvania will lose their healthcare during this process, creating a huge crisis in our communities. Nearly 1/3 of the people whose care will be stripped away in PA are children. But we all have rights! Everyone who is cut from Medicaid has the right to file for an appeal! We have to fight back along with everyone who is impacted! Join Put People First! PA to learn about what’s going on with Medicaid, what to look for and do to protect yourself, and how to file an appeal if you do get cut off. Learn your rights and connect with community. Join this movement. You are not alone!
Put People First! PA leader LT Talarico recently shared their story about what Medicaid access has meant to them — and what it will mean if they’re forced off of it in the coming months. Read their story reprinted below or share here: https://otherwords.org/a-health-care-cliff-is-coming/
A HEALTH CARE CLIFF IS COMING
I’m one of 18 million Americans who could soon lose Medicaid access. Here’s how to keep people from falling over the edge — and how to fight back.By LT Talarico | February 22, 2023
I’m one of the 84 million Americans who get our health care through Medicaid. And I’m one of the 18 million who might lose it starting this spring unless our policymakers take action.
I went to college, got a degree, and planned on being self-sufficient. But in my early 20s, I was struck by an autoimmune condition that caused painful, chronic flare ups that affected my ability to stand or walk.
I worked some desk jobs, but the health coverage was inadequate. I struggled financially, relied on thrift store wheelchairs, and lived with pain for 10 years before I got Medicaid. It changed my life — I was finally able to get a diagnosis and treatment. Today, I work as a dental hygienist.
But Medicaid is full of holes and paperwork. You have to reapply frequently. And small increases in income can throw you off the program, even if you don’t make enough to buy insurance on your own.
For a while, Medicaid was improved during the pandemic. In exchange for increased federal matching funds, states agreed not to kick anyone off the program until the end of the federal Public Health Emergency. We didn’t have to keep applying — we could focus on staying healthy, taking care of our families, and doing our jobs.
Children, Black, and Latinx people will be disproportionately affected. But people of all ages and races will be impacted. The majority of people on Medicaid are working class white people like me.
My modest pay is just high enough that I will likely lose coverage, and my contract job doesn’t offer health benefits. I can get a plan through my state’s disabled workers program or the Affordable Care Act’s marketplace, but if I have to pay those premiums, I’ll be living in fear of car repairs, extra medical bills, and rent increases.
Federal action to keep Americans from falling off this cliff is unlikely in a divided Congress. So states need to start preparing now to make sure eligible recipients don’t lose care.
States will need to do outreach to Medicaid patients, field questions, and re-enroll people with their existing information rather than requiring unnecessary paperwork that could result in them losing coverage. And they must broadcast widely that everyone has the legal right to file for an appeal if they’re cut.
States governments need to make sure renewal agencies have the correct mailing addresses, email addresses, and mobile numbers for enrollees. And they’ll need to collaborate with trusted community-based organizations to reach everyone who might be impacted.
Inexcusably, 11 states still refuse to expand Medicaid under the Affordable Care Act. That needs to change. But states that did expand Medicaid will cut patients off, too. In Pennsylvania, where I live, nearly 1.2 million could lose care.
The deeper problem is that our system treats health care as a source of profit for the wealthy. If we guaranteed health care as a public good, we could all get the care we need — with less paperwork and at lower cost than the private market.
Care should be a human right, for everyone — no matter where we live, what we look like, or how much money we make. That’s why I’m part of a national network called the Nonviolent Medicaid Army. We believe that those with the most to gain and least to lose from uprooting our profit-driven health care system must come together and fight back.
Wherever you live, you can do something! Share your story about why Medicaid matters to you, join up with us, and tell your policymakers to start preparing now.
Shapiro admin can do more as rollbacks to food and health benefits loom in Pa., experts say
by Katie Meyer of Spotlight PA |
Spotlight PA is an independent, nonpartisan newsroom powered by The Philadelphia Inquirer in partnership with PennLive/The Patriot-News, TribLIVE/Pittsburgh Tribune-Review, and WITF Public Media. Sign up for our free newsletters.
HARRISBURG — Hundreds of thousands of Pennsylvanians could lose their health insurance and nearly two million could face more food insecurity in the coming months due to two sweeping rollbacks to pandemic-era federal policies.
Advocates see the sudden reduction of benefits as a looming health and welfare crisis. But they also view it as an opportunity to push the commonwealth, and its new Democratic administration, to do more.
The federal government will soon end a “continuous enrollment” policy that has kept states from kicking people off Medicaid for three years and stop sending extra monthly payments from the Supplemental Nutrition Assistance Program, or SNAP.
It’s a double whammy for people who rely on both programs. Cassie Hill is one of them. Her pay is inconsistent, so she’s not sure if, in the past three years, she edged above the income range that qualifies her for Medicaid. She also doesn’t know how she’ll make her grocery budget work when she’s getting less money from SNAP.
The 26-year-old North Philadelphia resident works as a dog walker and a clerk at a co-op, and her salary fluctuates significantly from week to week because her hours and the number of dogs she walks vary. A good month can bring in about $2,000. A bad one brings less.
She’s in recovery for an eating disorder, and the ability to use Medicaid to see a therapist consistently has been “life-changing,” she said. “It’s definitely not something I could afford if I had to pay for it.”
Likewise, SNAP has allowed Hill some peace of mind when it comes to food.
“I have a hard time being able to consistently make myself food,” said Hill, who also advocates for health care access with the volunteer group Put People First! Pennsylvania. “A huge part of my life is making sure that I have a lot of things that I can just grab and go. And food stamps have been indispensable for that.”
The changes to SNAP and Medicaid that have been in place since 2020 have had a big impact. Supplemental SNAP payments have given Pennsylvania households that use the program at least an extra $95 per month, often more. And in 2022, the uninsured rate in the U.S. hit an all-time low of 8%.
Now, the federal government is ending both measures.
In March, SNAP recipients will go back to getting one payment a month. That means nearly two million people in Pennsylvania will see their monthly allotments shrink by $181 a month on average, according to the state Department of Human Services.
And in April, people will need to resume reenrolling in Medicaid annually.
The department estimates that roughly 618,000 people will lose their Medicaid coverage because they no longer qualify for the program. It is keeping a separate list of 598,000 Medicaid recipients who haven’t resubmitted their annual paperwork over the past three years and are considered to be at higher risk of losing benefits due to logistical issues, even if they still qualify.
The impact on food security will be “big, like really big,” said Joe Arthur, who heads the Central Pennsylvania Food Bank.
Arthur said that in the 27 counties his organization serves, the value of the lost SNAP benefits will total more than $40 million when the extra payments end in March.
“To put that into some perspective, that is more food value than our entire network, and others, that provide food assistance would provide in a month,” Arthur said.
Nijmie Dzurinko who, like Hill, is an organizer with Put People First! Pennsylvania, said her group thinks the likely loss of health care benefits will be similarly significant. Her group views the situation “as a crisis,” she said.
The Shapiro administration is primarily dealing with the rollbacks by trying to warn people about the changes to their benefits, and letting them know whether they have recourse under current law.
Over the past month, the administration has mailed letters to SNAP recipients warning them that February’s supplemental federal payment will be the last. Acting Department of Human Services Secretary Val Arkoosh is urging Pennsylvanians to donate to food pantries.
The administration is also reaching out to Medicaid recipients via “mail, text, email, and phone” to let them know they could lose coverage if they don’t reenroll in Medicaid beginning in April, DHS officials said in a statement. The date of expiration will depend on when a person’s Medicaid comes up for renewal; it happens annually at the date on which the person first got covered.
Advocates for guaranteed access to food and health care say they are concerned about the immediate impact on the people they work with. But they also see this rollback as an opportunity to push the administration to do more to take advantage of the existing opportunities states have to help people keep at least some of their benefits.
These include more quickly implementing a new federal requirement that would keep some from losing insurance coverage mid-year, passing legislation that would create state-funded food assistance payments, and exploring waiver options to further expand Medicaid.
“It shouldn’t just be kind of swept under the rug as ‘going back to normal,’” said Dzurinko. “It’s not actually a good normal that we had before.”
Acting Department of Human Services Secretary Val Arkoosh is urging Pennsylvanians to donate to food pantries.
Stopping the churn
Health care advocates argue there is at least one concrete step the state can take right now to mitigate coverage losses.
One of the biggest problems that advocates for greater insurance coverage often point to in the Medicaid system is “churn” — people repeatedly cycling on and off the program due to paperwork problems or temporary changes in financial status.
Churn is an especially big problem for children, said Carolyn Myers of Pennsylvania Partnerships for Children, which advocates for expanded health care coverage. Myers argues that these past three years of continuous coverage solved a lot of that problem, but now that’s about to change.
“There’s been a 20% increase over those three years of children enrolled in Medicaid,” she said. “It supports healthy development at an early age.”
Of the Pennsylvanians projected to lose Medicaid coverage in the next year, Pennsylvania Partnerships for Children estimates about 430,000 will be minors.
Myers thinks there’s a way to reduce that number.
For years, the federal government has given states an option aimed at addressing churn in minors: They can choose to allow continuous 12-month coverage for kids, as opposed to kicking them off the program mid-year if, for instance, their families’ financial circumstances change.
Not all states have taken advantage of that option, though, Pennsylvania among them. The commonwealth currently guarantees 12-month continuous coverage for all children in the Children’s Health Insurance Program, or CHIP, but guarantees continuous coverage under Medicaid only for children 4 and under.
That will soon change. The federal appropriations measure that decoupled Medicaid and SNAP benefits from the COVID-19 public health emergency also turned that option into a requirement: States must provide yearlong continuous coverage for people up to age 18 who are enrolled in both Medicaid and CHIP beginning in January 2024.
But Myers doesn’t think the commonwealth should wait until then to expand 12-month Medicaid coverage to older children and minors.
“There’s no reason why we can’t implement this policy now,” she said. “There’s no hurdle.”
Asked about the administration’s stance on those kinds of changes, Brandon Cwalina, a spokesperson for the Department of Human Services, said it “is open to exploring all options to improve the services we provide to Pennsylvanians,” though he didn’t offer more detail.
Cassie Hill is in recovery for an eating disorder, and the ability to use Medicaid to see a therapist consistently has been “life-changing,” she said.
‘A political will conversation’
Advocates are also highlighting several legislative and administrative steps they’d like to see lawmakers attempt.
When it comes to food security, both Arthur of the Central Pennsylvania Food Bank and Ann Sanders, a policy advocate with the Pittsburgh anti-hunger group Just Harvest, said the commonwealth already uses most available federal resources.
Pennsylvania has “done a pretty good job,” Sanders said, but added, the governor and legislature could still take cues from other states on ways to further ease burdens and “help people adjust to having less benefits.”
Organizers with Put People First! Pennsylvania are also calling on the state to create an official public health care advocate. That position, also pitched in an unsuccessful bill last legislative session, would “hold … governments and the private sector more accountable,” Dzurinko said.
“We have an ombudsman for utilities and all these other things, but we don’t have that for health care,” she added.
People who work with SNAP and Medicaid recipients are also keeping an eye on the Department of Human Services’ staffing levels as it begins reenrolling people. Although the department sent out reenrollment paperwork over the past three years, the process was largely a formality rather than something that would make or break people’s health coverage.
“They have a lot of vacancies right now, especially clerical workers, which is really problematic when you talk about them having to renew three million Medicaid cases,” said Sanders.
She’s concerned, she said, that around May, “we’ll really start seeing people who are like, ‘I know I turned in my renewal packet. Why is my coverage getting cut off?’”
Myers of Pennsylvania Partnerships for Children is also watching how the state handles the logistically demanding reenrollment process.
“We really want DHS to do everything possible to protect Pennsylvania children from getting caught up in red tape and losing their health insurance,” she said. “And honestly, the administration has its work cut out for it.”
Cwalina said in a statement that the Department of Human Services will be able to handle the influx of work.
“DHS’ Office of Income Maintenance (OIM) will continue to monitor workloads across the County Assistance Offices (CAOs) and move work as necessary to other locations in an effort to ensure it is completed within established timelines,” he said in an email. “This is a typical process.”
Others are looking ahead to potential ways the state can even further reduce loss of coverage, taking inspiration from other states that are pioneering permanent multiyear continuous Medicaid coverage.
Last year, Oregon became the first state to give children continuous Medicaid coverage from birth to age six, and also instituted two-year continuous coverage for children and adults six and older.
The state did this using a federal waiver that is designed to test new approaches to Medicaid coverage to see if they improve outcomes. If approved by the federal Department of Health and Human Services, these waivers often authorize new programs on a five-year basis, and require among other things that they not cost the federal government additional money.
Three other states — California, New Mexico, and Washington — are now pursuing similar waivers.
Elisabeth Burak, a senior fellow with the Georgetown University Center for Children and Families, said pandemic-era continuous enrollment has already given states an unusual opportunity to track the impact the change can make. In her opinion, that evidence has been compelling.
States like Oregon, she said, “saw the uninsurance rate drop for kids of color, you know, significantly, because they didn’t get disenrolled and come back on.”
“I do think it’s a common sense way to make sure your kids are staying on and they can get the care they need instead of, you know, having to deal with the added stress of coverage gap,” she said. “I think it’s going to be a political will conversation.”
Cwalina said the Shapiro administration is “open” to these measures, adding, “some of these changes would require federal or state legislative action and DHS stands ready to work with our respective delegations to consider additional ideas.”
