New Yorkers face challenges in navigating Medicaid recertification process

Months after the end of the Public Health Emergency declaration, New Yorkers and people across the country are navigating a bureaucratic transition due to the unwinding of the Medicaid continuous enrollment provision. 

During the COVID-19 pandemic, the federal government paused processes that Medicaid enrollees normally go through to renew their coverage. Now, states are restarting regular Medicaid renewals for the first time in three years. 

As a consequence, 9 million Medicaid enrollees will be required to update their coverage over the next year. This extensive renewal operation is expected to affect a substantial portion of the population that relies on Medicaid services.

The recertification journey is well underway across different states, with each progressing at its own pace. As of October 2023, 13% of New York enrollees whose coverage had been extended have had their coverage renewed, compared to 28% in Connecticut and 49% in Oregon, underscoring the state’s slow pace through the bureaucratic maze.

“It’s important to remember that transitioning out of Medicaid is not the same as ‘losing healthcare coverage.’ Many people will enroll in coverage through their employer or the Marketplaces. We are laser-focused on making sure people have health insurance and keep it,” Daniel Tsai, deputy administrator and director of the Centers for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services (CMS) told the Amsterdam News. 

While efforts are being made to ensure healthcare coverage continuity, concerns remain about the effectiveness of these measures. Jenny Palaguachi, a healthcare advocate with the Healthcare Education Project in Staten Island, explained the grassroots challenges surrounding Medicaid recertification. Palaguachi underscored a critical issue in the recertification process: “A lot of individuals are not aware that they are not automatically re-enrolled…when they come in to the doctor for their annual checkup or they come in because they’re feeling sick, they find out that they’re not active [in Medicaid].”

Maria Arnold, a Medicaid enrollee from Staten Island, highlighted a similar concern. She said that while healthcare professionals were getting the information about re-enrollment, the people who actually needed it weren’t. Like Palaguachi, she said many people were unaware that they had been dropped from the Medicaid rolls. “The Medicaid thing has been very hard for [seniors]. If you don’t have someone to explain the process for you, you can get dropped out without even knowing it.”

With the aid of community organizations, Arnold was able to find help and navigate through the complex Medicaid system. Her experience illuminates the critical role community organizations play in helping individuals understand and access the healthcare resources available to them. 

The advocacy from community organizations calling for clear, timely communication and robust support mechanisms to navigate this transitional phase is resonating across New York’s boroughs.

In the midst of the unwinding process in New York, healthcare organizations are stepping up to ensure that their members are not left stranded. Amida Care, a nonprofit community health plan that specializes in providing comprehensive health coverage to those with chronic conditions, like HIV and behavioral health disorders, shed light on the hurdles and the initiatives underway to provide a safety net for its vulnerable members.

Addressing the challenges faced by these individuals, especially those without stable housing, the organization has embarked on a robust outreach mission. “Many of [the members] may be couch surfing, don’t have a permanent residence, or [are] moving from house to house. The initial work was around ensuring that their contact information was…updated,” said Sylvia Cowan, vice president of customer experience and growth, who is leading Amida Care’s retention efforts. This proactive step, aimed at preventing disenrollment due to outdated contact information, is part of a broader strategy to retain their members.

There is a similar sentiment on the frontlines of this issue. Hondo Martinez, a community outreach manager from VNS Health, one of the country’s largest home and community-based healthcare nonprofits, outlined the disparities inherent in the recertification process, particularly emphasizing the challenges that marginalized communities face. According to Martinez, the barriers are multifaceted. “[Some]…low income [people]…don’t have a phone. They don’t have unlimited data plans, so they can’t access that toll-free line to do the research.”

Those who have coverage through the marketplace can access their accounts by calling 1-855-355-5777 to reach the NYS Marketplace and renew their Medicaid coverage. Having a Marketplace account means an individual has registered and created an account on the NYS Marketplace. For those not part of the Marketplace in the city, such as individuals who receive Medicaid directly, the recertification process might occur in person at their local Department of Social Services (HRS). 

This dichotomy exacerbates the difficulty for those lacking stable housing or phone access, rendering the recertification process a daunting task. 

Despite these challenges, VNS Health, like Amida Care, is continuing to reach out to the community. Martinez said, “We’re near hospitals, clinics, train stations, major hubs for buses or subways, so we’re really trying to target everyone. Cast this wide net, and just as they’re passing by, just announce to them, ‘Hey, do you have Medicaid? Do you need coverage? Do you need help with recertifying?’ Although it’s limited just to give them that information.”

The re-enrollment process will vary based on how someone is enrolled—whether through NY State of Health, New York City Health Resources Administration, or the local Department of Social Services. Resources and detailed contact information and steps to re-enroll are available at https://info.nystateofhealth.ny.gov/COVID-19-Changes. Medicaid beneficiaries should ensure that their mailing address is updated, and keep an eye out for a letter or renewal packet.

Information and steps to re-enroll in Medicaid: 

https://info.nystateofhealth.ny.gov/COVID-19-Changes

You can reach NY State of Health by calling them toll-free at 1-855-355-5777 (TTY: 1-800-662-1220).

Correction: This article has been updated to reflect that VNS Health is one of the country’s largest home and community-based healthcare nonprofits, not one of the country’s largest community-based healthcare organizations.