Brenda Pike was struggling to control the scattered, incoherent thoughts racing through her mind when she walked into a Walgreens drugstore in Savage a few weeks ago to fill her monthly prescription for antidepressants.
It was only then that Pike, who suffers from bipolar disorder and severe depression, learned that she had been dropped from Medicaid coverage and the pharmacy had no way to fill her prescription.
“I started to panic because the meds are what keep me stable,” she said. “Without them, it feels like a tornado is racing through my head and everything gets tossed upside down.”
Pike, who drives for Uber, is among hundreds of Minnesotans who have lost their Medicaid coverage since the state implemented new financial reporting requirements aimed at reducing fraud and waste in the joint state and federal health insurance program.
In late August, the Minnesota Department of Human Services (DHS) began requiring that people on Medical Assistance, Minnesota’s version of Medicaid, fill out a two-page form that enables the state to verify that their assets do not exceed eligibility limits. However, people were given just a 10-day grace period if they failed to return the form by mid-September. Many were unable to meet the tight deadline and were “disenrolled” from Medicaid, creating turmoil for those with urgent or life-threatening medical needs.
The DHS, which oversees Medical Assistance, disclosed this week that approximately 1,300 people — including some who are sick, elderly or have a disability — have lost their coverage since the new asset-verification policy went into effect last month. Hundreds more are at risk of losing coverage as the agency rolls out the new system statewide through next spring.
Advocacy groups for people with mental illness said the state should have publicized the new asset-verification policy much earlier and given people more time to submit the forms before terminating coverage. Some people only discovered the new requirements after they arrived at a pharmacy or a clinic and were told they had been dropped from Medicaid coverage. The change has forced an unknown number of people, such as Pike, to go without vital medical care while they scramble to reinstate their benefits, advocates said.
“For so many people, their medications and their treatment are how they are able to be alive and be well in the community,” said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. “To add a new requirement without ample notice is unconscionable.”
The troubles stem from a federal law that requires states to maintain an electronic system for searching people’s financial records to determine quickly if those enrolled in Medicaid are eligible, and to search for any unreported financial accounts. The DHS began implementing its system, known as the Account Validation Service, in September. Under the new system, Medicaid applicants and enrollees had to sign and submit a form authorizing the DHS to access information held by financial institutions. Individuals who failed to return the authorization form by the deadline listed on the form risked losing their coverage.
The DHS mailed the new forms to about 28,000 enrollees in Medical Assistance in late August and will continue the mailings in batches through March 2020. All Medicaid enrollees statewide who are 65 or older, blind or have a disability (and who are subject to an asset limit) will have been sent the form once the last mailing is complete, DHS officials said. So far, nearly 95% of those who received the notices continue to have coverage, according to the agency.
DHS officials said they notified community health providers, managed care organizations and advocacy groups about the new policy earlier this year, so they could help people return the forms and maintain health coverage. After the first batch of forms was sent, the agency started mailing the notices five to six days sooner to provide additional time for enrollees to respond, officials said.
“Our priority is to ensure that qualifying Minnesotans have access to the health coverage they need,” acting assistant DHS commissioner Tom Moss said in a written statement. “Staff have been working with partners, advocacy groups and stakeholders to minimize coverage closures for failure to return this authorization form.”
Despite this outreach effort, many people on Medical Assistance said they were never told of the coming changes. As a result, they may not have checked their mail for the authorization forms. Other people with intellectual or developmental disabilities may have received the form but not understood its significance.
“A lot of people with depression or schizophrenia are not opening their mail every day, and they easily could have missed this,” Abderholden said.
A spokeswoman for Hennepin Healthcare, which operates HCMC in downtown Minneapolis, said its counselors have already seen a few patients who had lost Medicaid coverage because of the new requirements, but counselors expect the numbers to grow as the new system is rolled out statewide.
Jean Tracy of Pine City said she is “deeply concerned” that her younger sister, who suffers from paranoia and schizophrenia, is among those who was cut off from Medicaid. Last month, her sister was hospitalized in St. Cloud after a mental health crisis during the time period in which the forms were sent. A county case manager recently told the family that she had missed the deadline.
Now Tracy is afraid that her sister will be unable to pay for her antipsychotic medications once she leaves the hospital and may “end up on the streets.”
“This is life or death for some people,” Tracy said. “She may not reach out for help until it’s too late.”
State officials are encouraging Medical Assistance enrollees who lose their coverage to reach out to their county offices for guidance on how to reapply. People can get retroactive coverage for up to three months.
Early this week, Pike took a break from transporting Uber passengers to drop off paperwork at a Scott County office that, she hopes, will reinstate her coverage. By Wednesday, however, she still had no insurance and no access to care. The clinic where she goes for weekly mental health counseling had just sent her a “denial of payment” notice in the mail.
Pike rocked back and forth nervously in her chair as she described her unpredictable mood swings and fears of sinking deeper into depression.
“The hardest part is I don’t know what I will be feeling from hour to hour, minute to minute,” she said. “I’m just so desperate to resolve this.”