Access to health care cannot be tossed aside

Medicaid has been sending letters to millions of patients across the country that is critical to their futures — and if ignored, it can cost them their health. 

Starting this month in Illinois, the Illinois Department of Healthcare and Family Services has been mailing letters to covered individuals stating that they must choose a managed Medicaid plan within 30 days or they will be automatically assigned to a plan based on factors such as home address and the network of their primary care provider. 

In Colorado, some 1.8 million pieces of mail from government sources to program recipients, including Medicaid, are returned each year as they are deemed undeliverable. In Louisiana recently, 46,000 Medicaid recipients lost coverage because they did not respond to mailings. This is happening in every state. 

There are 3.1 million Medicaid recipients in the state of Illinois, which is about 25 percent of the state population. About 47 percent of Illinois Medicaid recipients live in Cook County. 

Medicaid is automatically assigning enrollees without evaluating the quality of the insurance plan or whether complex care needs will require visits to multiple specialists. 

Working as a pediatric rehabilitation physician for the past eight years, treating thousands of patients with lifetime disabilities, losing a patient to follow up for an extended period can be detrimental, resulting in the inability to obtain medications, braces, equipment, and therapies that can sometimes lead to hospitalizations or surgeries. 

When patients are lost to follow up, they often return in dire need of interventions that may not have been necessary had they continued to receive regular medical care. Denying access to healthcare to a child is a form of neglect and should not be allowed based on whether someone failed to read a letter or errors made in a computer system.

Patients often choose a primary care doctor close to home so that sick visits and regular checkups will be convenient. They then use a more extensive hospital system farther from home for their appointments with a specialist.

Reassigning a patient into a plan that allows them to see their primary care provider but does not allow the patient to see their specialty providers results in patients being lost to follow up for several months. 

I know firsthand that this is harmful. 

Recently, I saw a 15-year-old boy who had been lost to follow up for more than a year. He had cerebral palsy with spastic quadriplegia, seizures, and a feeding tube. His mother continued to qualify for Medicaid. Yet, this child was unable to receive new foot braces to help with standing or positioning, and his mother was forced to purchase all medications out of pocket because her Medicaid enrollment status was listed as inactive in the computer system. 

Without insurance coverage, she was forced to place specific treatments on hold due to cost and purchase the medicines that she could afford with her income. This was a hardship. 

In another instance, six pediatric residents in a Chicago area nursing home have been waiting to get re-enrolled in Medicaid for one year. A reassignment or disenrollment that can result in the loss of health care insurance benefits for six months or more is unacceptable. 

The goal of managed care is to limit the expense of health care. But it seems the most significant cost savings is resulting from inadvertent dis-enrollments and automatic reassignments.

When a patient is uninsured or unable to see their specialists because they are no longer in-network, no medical care is administered. When no health care is provided, Medicaid saves even more than they would have had the patient gone into a regular managed care plan.

But the cost is too grave. According to data from the Journal of Law, Medicine & Ethics, patients who are auto-assigned use less outpatient care, and if they remain uninsured for lengthy periods, they eventually end up in emergency rooms. This is less efficient and more costly for the entire health-care system. 

I see this regularly in my outpatient clinics.

Medicaid states that as a new enrollee, you can change your health plan one time in the first 90 days. After that, you cannot change your health insurance plan for one year. If you choose to change your policy at a later date, this can only be done during the annual open enrollment period. 

For children with special needs, Medicaid has developed a solution. Families of children who are receiving Supplemental Security Income, enrolled in the Division of Specialized Care for Children CORE program, or have a physical disability, will be mailed enrollment packets from Illinois Client Enrollment Services to enroll in a HealthChoice Illinois plan.

These letters will arrive in December and need to be read carefully. If a plan is not chosen by the deadline outlined in the letter, a plan will be automatically assigned. Medicaid recipients will have an additional 90 days after Feb. 1 to make a one-time switch. After the 90 days, members will be locked into their health plan for one year. 

The consequences of missing this letter may be the difference between access to regular medical care and missing out on essential treatments, therapies, and medications. Families who may have been displaced or have recently moved can miss this single opportunity to have continuity of care.  

Acting on this one crucial letter may be the difference between accessing health care promptly and having to wait for months to be placed in a managed care plan that meets their needs.  

This year, losing health-care access should not be on anyone’s wish list. 

Laura Deon, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Rush University Medical Center, where she specializes in Pediatric Rehabilitation. She teaches the Health Equity and Social Justice Course at Rush Medical College and is a Public Voices Fellow through The OpEd Project.