A new program requiring face-to-face meetings for Medicaid recipients has contributed to over 55,000 children being dropped from state rolls. At a meeting of the Legislative Budget Committee last Thursday, Bob Robinson, executive director of the state's division of Medicaid, presented the agency's proposed budget to legislators and lauded the reduction in rolls for the money it had saved the state.
The new re-certification process, which began last year, requires Medicaid recipients to prove their eligibility in a face-to-face meeting with a case worker. In past years, recipients only had to fill out a form and return it to the state. Under the new program, recipients are sent one letter informing them of the requirement. If they fail to make the appointment, they are dropped from Medicaid.
Few states use such a demanding procedure. In fact, Pam Shaw of the Children's Defense Fund says that Mississippi is the only state that requires face-to-face meetings for both entry into the program and re-certification. At the committee meeting, Robinson said he believes that 10 states require face-to-face meetings for re-certification.
The proposed budget calls for approximately $530 million in state general funds as part of an overall $4 billion budget, the majority of which comes from the federal government. The $4 billion budget represents a reduction of around $500 million last year, the first reduction since at least 2000. The savings come from $275 million in pharmaceutical savings, largely resulting from last year's measure restricting Medicaid recipients to no more than two brand-name and two generic prescriptions, along with the reduction in Medicaid rolls.
At the meeting on Thursday, House Public Health and Human Services Committee Chairman Steve Holland, D-Plantersville, asked whether recipients had simply been dropped from the rolls because they missed their meetings.
"It's a combination of factors," Robinson replied. "Some have higher income. They're no longer eligible or they have never been eligible in the first place."
Under continued questioning, however, Robinson acknowledged, "We have a lot of people who don't show up." Robinson said he believed that most of those dropped were adults.
State rolls, however, show that the CHIP program, which supplements Medicaid, has 8,271 fewer children enrolled than in January 2005, while Medicaid has 46,684 fewer children enrolled.
Shaw said that the re-certification process is an unnecessary burden on working families. "There are 30 Medicaid regional offices where people can have these meetings," she said, "but we have 82 counties in Mississippi. So you have working people having to get transportation, take time off work and drive across counties in some instance just to recertify. They've already proven once that they're eligible."
Shaw also worries that many recipients are receiving sufficient notice of the required meetings. "I talked to a woman the other day who was given only 12 days' notice. You have longer than that to pay your bills," she said.
"It's one of those situations where theory and practice are night and day," Holland said this Tuesday. "I think where we are now is that the recertification process has an attitude problem. They're using it to cull people from the rolls instead of really determining eligibility."
Holland expressed concern that as the rolls were being reduced, the state had virtually ceased outreach to bring eligible children into the program.
"Doctors are telling us that they're seeing more children showing up in emergency rooms without insurance," Shaw said. "So how do you want to spend your money, prevention or emergency care? Fewer and fewer children will have insurance under this program, and we will all pay for that in the long run."
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