Former Beneficiaries Speak Out on Ways to Prevent Eligible Individuals from Losing Coverage

(NEW YORK) – Approximately one-third of enrollees in New York State’s public health insurance programs—Medicaid, Child Heath Plus, and Family Health Plus—fail to complete the annual recertification process and lose coverage despite remaining eligible, according to a new study released today by the New York State Health Foundation (NYSHealth) and conducted by Lake Research Partners. Some former beneficiaries manage to reenroll months later, resulting in a high churn rate that undermines efforts to provide continuous and stable health insurance to low-income New Yorkers.

“The challenges we face in recertification seriously limit the impact of our public health insurance programs, resulting in higher costs and poorer health outcomes for the individuals they are designed to serve,” said NYSHealth President and CEO James R. Knickman. “In this weak economic climate, we cannot afford to let the coverage of so many New Yorkers systematically lapse.”

The findings result from focus groups that were conducted in Albany, Buffalo, and New York City with former program beneficiaries to identify the barriers and potential solutions to the problems individuals face during the recertification process. Groups were conducted in English, Spanish and Chinese. The study found that many former beneficiaries were unaware they had lost their coverage; that most former beneficiaries had not found alternative coverage options; and that all valued the public programs and wanted to stay enrolled. According to these recent disenrollees, the key barriers to recertification include: misconceptions about eligibility, confusion about the recertification process, an abundance of paperwork requirements, language issues, and the complicated nature of their lives.

“New Yorkers told compelling stories about how losing health coverage had real consequences for their lives. For children and adults, it results in fewer regular check-ups, less access to primary care, increased complications from chronic conditions like diabetes, and a greater reliance on costly emergency room visits for care,” said Michael Perry of Lake Research Partners.

Former beneficiaries also recommended solutions to improve retention rates, including:

• creating telephone recertification or online recertification options;
• providing “pre-populated” recertification forms with data from original enrollment applications or recent applications;
• sending telephone, e-mail or text reminders when deadlines approach;
• using “recertification facilitators” to help those with questions or specific needs;
• eliminating or reducing the need to visit local Department of Social Services  offices to complete the recertification process; and
• offering recertification forms in multiple languages.

“New York State is implementing steps to simplify and streamline its public health insurance programs. The effort underway to establish a new statewide enrollment center and allow for telephone renewal will give beneficiaries exactly what they say they need and go a long way to creating more continuous coverage,” said NYSHealth Senior Vice President David Sandman. “Keeping eligible people enrolled is just as important as signing them up in the first place.”

Currently, some 2.5 million New Yorkers are living without health insurance and that number is expected to grow as workers lose access to employer-sponsored health plans through cut-backs or layoffs. Approximately 4.6 million New Yorkers rely on Medicaid, Child Health Plus, and Family Health Plus for health insurance. Improving how these safety net programs function is essential to combating the rise in the number of uninsured New Yorkers. This study is part of NYSHealth’s broader initiative to expand health insurance coverage throughout the State. NYSHealth has committed $20 million in grant funding to reduce the number of uninsured New Yorkers.