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Eva Bednar’s 44-year-old son Andrew is an epileptic, he has been diagnosed with intermitent explosive disorder and he is borderline intellectually disabled. This summer he was one of thousands of adults who the Pennsylvania Department of Public Welfare cut from its medical assistance program for the poor and disabled.
Andrew lives in an apartment in Avalon but his mother handles his paperwork. "It used to be once you got on maybe three years later they would send you a form and ask you to be recertified," said Eva Bednar. However, this summer Andrew was disenrolled and that meant more work for his mother.
"It took multiple telephone calls to get, the first thing that happens when you send in they give you this form and it has this number on top so you send it in so...when you send it in and when I call, when I finally do get somebody they tell me they can’t find it."
It was several months before he was back on medical assistance.
In August of 2012 there were 46,000 fewer Pennsylvanians enrolled in Medicaid than there were in August of 2011.
The DPW says cutting recipients is saving the department and the cash-strapped state money. It says incomplete paperwork and removing those who are no longer eligible for the program are the reasons for the bulk of the reduction. Anne Bale, the Department’s spokesperson, says they even found 3,800 registered recipients who were dead.
"That reflects the importance of why we needed to do this," she said.
By law, Medicaid recipients must prove their eligibility every six months. However, many social workers in county assistance offices, faced with larger and larger caseloads, did not enforce the rule. Then, last summer, the Department of Public Welfare set out to catch up on a backlog that had been building for years.
"So, its us trying to strike a balance of making sure those who need it, have it, and those who are not eligible, are not on the program," said Bale.
The Department gave most recipients a deadline, in some cases ten days to two weeks, to get documents to the assistance offices or risk losing coverage. Some Medicaid recipients didn’t get the letters. Many went to the wrong address. Some of those who did get the letters couldn’t understand them. Others sent in their information – but it wasn’t processed in time.
If paperwork isn’t processed within 30 days, recipients have to reapply from scratch. By the time the new paperwork could be submitted, thousands lost their healthcare coverage.
Beth Ann Mikus is an income maintenance caseworker supervisor with DPW. She’s also a representative for the Service Employees International Union, in Allegheny County. She said the past year has been difficult for the caseworkers who handle upwards of 1,600 cases each.
"There was no way these thousands and thousands of applications could be processed in a timely manner or could be processed at all," she said.
Mikus calls it a system failure. She says over the years, the department has drastically cut the number of caseworkers, which in some cases has lead to paperwork not getting scanned into the system and the backlog getting even deeper. Caseworkers from neighboring less populated counties were called in to assist – even though they had their own caseloads to take care of. The intake department was then getting flooded and the process slowed even more.
The enrollment and disenrollment of eligible recipients is called churn. Tricia Brooks is an assistant research professor at the Georgetown Health Policy Institute. She says this process may be costing states money in the long run.
"Churn drives up a state’s administrative expenses because they have to close a case and then process new applications within a matter of weeks or months. Secondly, those gaps in coverage for people are also very expensive,” said Brooks. “We have a number of studies that have shown that there is an increase in hospitalizations following gaps in coverage. And then third we can’t manage the quality of our managed care plans if we don’t have continuous enrollment.”
Some states are implementing practices to increase the enrollment of children on Medicaid to earn performance bonuses from the federal government.
Ann Bacharach is the Special Projects Director for the Pennsylvania Health Law Project. Her organization, which helps people maneuver through the medical assistance program, has been inundated over the past year with calls and emails from people who have lost coverage.
In many cases, people don’t realize they have lost coverage until they go to see a doctor. Bacharach said its been a challenge to get people enrolled again and her group has seen a decline in the number of children enrolled in Medicaid who are not getting enrolled again – and that has her concerned.
The Pennsylvania Health Law Project has been hearing stories of the needy going without care – Janice Meinert, a paralegal, has been fielding a lot of these concerns.
"They delay care [for] everything from a doctor’s appointment to medications they should be taking," she said.
The fluctuating number of people who are on-again, off-again Medicaid enrollees is in sharp contrast with the thousands of people who now qualify for the food stamp program but didn’t a year ago.
For Jenifer Bevans who lives in rural Washington County, going without care for her 7-year-old son Connor, was not an option. Connor, who is autistic, requires several therapy sessions and was still using “pull-ups” when he was disenrolled.
Bevans spent hours over the ensuing months trying to get through to her county assistance office. She managed to keep his benefits by narrowly scheduling an appeal hearing before the deadline.
"If I would have lost it I would have had to pay everything for all the services that he had. I looked back on the computer it was about a two, to a two and half month time period if we would have lost that," she said.
The Department of Public Welfare says it is caught up with the initial backlog and, as is required by law, it will continue the semiannual redetermination process.
Tricia Brooks at the Georgetown Health Policy Institute said Pennsylvania’s system begs a harder look.
"I am not aware of any other state, particularly in this economy that has seen the kind of drop in enrollment that you’ve seen in Pennsylvania so clearly something is more askew in Pennsylvania than elsewhere," she said.
Under the Affordable Care Act, re-determinations will be done once a year. Workers say that might lessen the load. But with the Act, Medicaid could also add 800,000 new recipients in Pennsylvania - which might leave workers, advocates and recipients facing the same issues they are today.
This story is part of a collaboration between 90.5 WESA, NPR and Kaiser Health News.
