For nearly a decade, Ohio saw significant progress in its efforts to make sure every child has health insurance, expanding Medicaid enrollment to more than 1.2 million children.
The state is now losing ground.
As of May, nearly 37,000 fewer children were enrolled in Ohio’s Medicaid program compared to February 2018, a loss of about 3% over 15 months, according to state data.
Census data, reported in the Annie E. Casey Foundation’s 2019 Kids Count report, also shows an increase of 30,000 more children without health insurance of any kind from the years 2016-17.
No one knows for sure why.
Child advocacy organizations are sounding alarms about the increases in children without health insurance in Ohio, largely rejecting previous optimistic explanations from the state that the economy’s improvement allowed families to move from government to private insurance.
“I just don’t buy it,” Akron Children’s Hospital CEO Emeritus Bill Considine said.
The state numbers mirror national trends. Enrollment for children in Medicaid and the Children’s Health Insurance Program fell by nearly 730,000 nationwide from December 2017 to December 2018, according to data from the Kaiser Family Foundation.
Organizations across the state like the Children’s Defense Fund, the Ohio Poverty Law Center and Voices For Ohio's Children are pushing the state to investigate the dropping numbers and to simplify a re-enrollment process that can be cumbersome, particularly for those in poverty.
“Certain kids are falling through the cracks and not getting medical care that they are entitled to get,” Considine said.
Maureen Corcoran, who took over this year as state director of the Department of Medicaid, said her team is thoroughly reviewing the declines, and is working to improve the state’s outreach to enrollees.
“There’s no question we need to do more,” Corcoran said.
It’s been happening more and more.
“People come to me and they say, ‘I went to pick up my prescriptions and I didn’t have Medicaid and I don't know why,’ ” said Lori Jensen, a certified application counselor at AxessPointe Community Health Center in Barberton. Her job is to help people apply for health insurance, usually through the state-run Medicaid program for the poor and disabled.
From 2017 to 2019, AxessPointe, which has clinics in Summit and Portage counties, saw a slight uptick in the percentage of uninsured pediatric patients and a decrease in the percentage of children on Medicaid.
While the Medicaid enrollment process is complicated and lengthy, taking months to process, the re-enrollment process can also be a hindrance, Jensen said.
Some people receive the renewal paperwork in the mail but don’t understand it. Others don’t receive the paperwork because they moved one or more times in the last year.
If they don’t know within 60 days that they lost their insurance, they have to start from the beginning with a new application.
Stephanie Dodson of Summit County Job and Family Services said the agency has worked to make the re-enrollment process easier. A statewide customer service phone number funnels all calls for help through one center, but after entering a ZIP code, a caller is directed to the county office. Wait times can be long, she said, but callers can opt to receive a call back so they don’t have to hold on the line.
“If they call in, we don’t even need a paper application anymore,” Dodson said. Her office also has case managers in places like hospitals, senior centers and even the I Promise School in Akron who help people fill out their paperwork.
But statewide, federal funding for people who can help the public enroll in health insurance has nearly evaporated in the last three years.
The Affordable Care Act created jobs for “navigators,” federally funded workers who helped people enroll in a marketplace plan or Medicaid. In 2016, Ohio received $1.9 million for the navigators. The next year: just $82,360. The amount rebounded somewhat to $316,818 for 2018.
“There's just a lot less people out there assisting Ohioans eligible for Medicaid [to] enroll,” said Graham Bowman, an attorney with the Ohio Poverty Law Center.
And when parents lose insurance, he said, more often than not, so do their children.
When a person is no longer enrolled in Medicaid and his or her case is closed, the case is coded with a reason that individual is no longer covered by the public health insurance program.
Just 12 percent of cases for people 20 or younger in 2018 were closed because of an “income-related issue,” indicating the individual or family now made too much money to qualify for Medicaid. About half of closed cases were due to failure to comply, likely meaning proper paperwork was not filed.
Kathleen Gmeiner, formerly of Voices for Ohio’s Children, authored a report on Medicaid data for children in Ohio just before she left the organization in May. She said it’s possible others whose cases were coded “failure to comply” also had earned more income or were hired into jobs with health insurance, and neglected to inform the state.
But the state has not reached out to those people to make sure they are leaving Medicaid intentionally, Gmeiner said.
“They're the only ones who can really know this,” she said. “In our report, we encourage them to do aggressive outreach where children were losing Medicaid to determine if they got other coverage or not.”
Corcoran, the Medicaid director, said she’s working to bring the program’s systems into the “modern era.” While people can fill out their Medicaid paperwork online, the state can’t send people their information in an email. She acknowledged the snail mail system isn’t a reliable way to reach people who move frequently.
Most reminder phone calls from the state are automated, but Corcoran said she wants to change that. An executive order signed by Gov. Mike DeWine also aims to increase data sharing between agencies, helping ensure fewer families fall through the cracks.
“We do have an active effort going on right now to focus on this from both a system point of view and from a human point of view,” Corcoran said.
For the advocates who have pushed for increased coverage for years, the declines are “disheartening," said Brandi Slaughter, project manager for Voices for Ohio's Children.
“Kids do better when their health needs are met,” she said. “Families have greater stability when they are not choosing between paying their utilities and doctors appointments.”
Contact Jennifer Pignolet at firstname.lastname@example.org, at 330-996-3216 or on Twitter @JenPignolet.