As Medicaid unwinding progresses, rural Americans face significant challenges. Limited access to navigators and procedural disenrollments threaten their healthcare coverage. Rural Medicaid recipients must overcome additional barriers like distance to eligibility offices and limited internet access. Experts worry that mishandling the unwinding process will strain rural communities already grappling with healthcare provider shortages and hospital closures. Ensuring access to navigators is crucial, as independent online searches for coverage often lead to misleading information. Tracking call center statistics, especially the “call abandonment rate,” will be vital to address rural concerns during the ongoing Medicaid transition.
In the heart of Carson City, Nevada, Abby Madore dedicates her days to assisting low-income residents in navigating the complex world of health insurance, including Medicaid. Her phone is a constant companion, receiving calls from clients scattered across the state’s vast and remote regions, all seeking guidance.
This year, her role has grown even more significant as states grapple with unraveling the Medicaid rolls after the end of a pandemic-induced freeze that prevented disenrollment.
Madore is one of several specialists employed by seven navigator organizations tasked with helping Nevada residents either enroll in or maintain their Medicaid coverage. Her primary focus lies on rural Nevada, a sprawling expanse covering over 90,000 square miles.
Communications officer Katie Charleson of Nevada’s state health marketplace acknowledges the persistent challenge of reaching residents in rural areas. This issue isn’t unique to Nevada and is a cause for concern, as experts fear that limited resources may leave rural Americans in a vulnerable position as Medicaid unwinding progresses.
KFF’s Medicaid Enrollment and Unwinding Tracker reveals that 72% of individuals who lost Medicaid coverage during the unwinding process did so for procedural reasons, not because they were deemed ineligible for the program.
By late August, federal authorities directed state Medicaid administrators to temporarily halt some procedural disenrollments and reinstate coverage for some recipients who had been dropped.
Experts worry that these procedural disenrollments may disproportionately impact rural populations.
A recent brief by researchers from the Georgetown University Center for Children and Families highlights the additional challenges faced by rural Medicaid recipients when renewing their coverage. These challenges include longer distances to eligibility offices and limited internet access.
Nationally, Medicaid and CHIP cover 47% of children and 18% of adults in small towns and rural areas, compared to 40% of children and 15% of adults in metropolitan counties.
Joan Alker, one of the brief’s co-authors and the executive director of the Center for Children and Families, emphasizes the critical role Medicaid plays in rural communities’ healthcare systems for families and children. She warns that mishandling the unwinding process could further strain these communities, which are already struggling to maintain an adequate number of healthcare providers and hospitals.
The lack of access to navigators in rural areas to help Medicaid enrollees maintain their coverage or explore alternative insurance options if they become ineligible could exacerbate the challenges faced by rural residents. Navigators assist consumers in determining their eligibility for Medicaid or CHIP and guide them through the enrollment process. If clients do not qualify for these programs, navigators help them enroll in marketplace plans.
Navigators operate independently from Nevada’s over 200 call center staff who assist residents with managing social service benefits. Unlike insurance broker agents who earn commissions on specific health plans, navigators are federally mandated to offer their services at no cost to consumers and provide unbiased guidance.
In Nevada, roughly 30 to 40 certified enrollment counselors, including Madore, work at navigator organizations, assisting consumers in enrolling in plans through Nevada Health Link, the state’s health marketplace that offers Affordable Care Act plans. Most of these organizations are situated in urban centers like Reno and Las Vegas, with only a few located in rural areas such as Carson City.
The availability of navigators and their outreach methods differ from state to state. Montana, for example, with a larger landmass but a smaller population compared to Nevada, has only six navigators covering the entire state. These navigators serve Medicaid beneficiaries and those seeking coverage through phone consultations and in-person visits to remote communities, bridging gaps in accessibility.
The unwinding of Medicaid makes the role of navigators even more crucial, according to Alker. A recent survey highlighted the challenges faced by consumers attempting to independently search for health coverage online. Many former Medicaid enrollees were exposed to aggressive and misleading marketing of limited-benefit products that do not cover essential services and expose consumers to high health costs.
The survey reported that none of the 20 sales representatives who responded to queries mentioned the availability of plans with no premiums or deductibles on the ACA marketplace, and more than half promoted limited-benefit products. Some representatives made false or misleading statements about the plans they were promoting and misrepresented the affordability of marketplace plans.
The inability to access navigators may leave consumers without proper guidance, potentially resulting in inadequate coverage choices. Unfortunately, the federal government does not require states to break down Medicaid disenrollment data by county, making it challenging for experts and researchers to differentiate between rural and urban concerns.
As the unwinding process continues, tracking call center statistics, including the “call abandonment rate,” will be crucial, particularly for rural areas where phone-based renewal of coverage is prevalent.
Concerns have already arisen in Nevada, where the average call abandonment rate was 56% in May, the first month after the unwinding began. Federal authorities have expressed apprehension about the impact on equitable access to assistance and the ability to apply for or renew Medicaid and CHIP coverage by phone.
The challenges faced by rural Americans during the Medicaid unwinding process are considerable. The availability of navigators, the outreach strategies, and the accuracy of information provided to consumers are all vital factors in ensuring that those in rural areas receive the healthcare coverage they need and deserve.
