New report highlights Medicaid access challenges, offers recommendations

By: - February 1, 2022 4:46 pm

The report released Tuesday made several recommendations for lawmakers and state agencies. (John Moore | New Hampshire Bulletin)

The challenges and shortcomings of Medicaid are many for the 202,000 Granite Staters who receive it and the countless others who could but don’t, public health advocates say.

Women whose pregnancy qualifies them for Medicaid lose their benefits 60 days after delivery. Tooth extractions must be covered for adults on Medicaid, but not their less-expensive preventative care. And immigrant children and pregnant women must be residents for five years to become eligible, a waiting period most states have waived.

There is legislation in the works to tackle those issues, including adult dental benefits proposed in House Bill 103 and Senate Bill 422, and expanded benefits for children and postpartum care in House Bill 1578.

Tuesday, a pair of advocacy organizations, Rights & Democracy and The Center for Public Democracy, released their report “Sick of Waiting: Barriers to Medicaid Keep Healthcare Out of Reach” to highlight access challenges – and recommended improvements.

In their survey of New Hampshire Medicaid recipients, 44 percent said they had long wait times when they called an office to apply for new benefits or renew existing benefits, and 20 percent said the application website was difficult to navigate. Eleven percent cited the lack of a nearby office as a barrier, and 31 percent said shame or stigma was a hurdle.

The application process was a problem for Melissa Bernardin of Concord.

When Bernardin became eligible for expanded Medicaid during the pandemic, which is based only on income, she was told the application would take 30 minutes. It took her three hours and required hunting down several documents that are required for regular Medicaid but not expanded Medicaid.

When Bernardin inquired, she was told the state’s Medicaid application portal does not distinguish between the two programs and, as a result, requires the same exhaustive set of records from everyone.  

“I think that is a huge barrier for people who don’t have time privilege, who don’t have access to a permanent set of records,” Bernardin said during a press conference Tuesday. “They may have moved or their lives may be disrupted. They may have domestic violence going on. I plead with anyone who can influence a reform of the state computer system to please do so because I’m concerned about the people who did not have the time privilege that I did to spend three hours on that process.”

The application was also a barrier for Marcella Termini of Manchester – but not the first one. 

When her twin sons were 3, they were diagnosed with autism and required services the family’s private health plan did not cover. None of the boys’ health care providers told Termini and her husband their sons were eligible for Medicaid. 

They learned that from New Hampshire Family Voices, a nonprofit she still refers families to. And like Bernardin, Termini found the initial application and renewal process far more cumbersome and time consuming than she was told.

“I personally set aside a full day,” she said Tuesday. “And I send my family out of the house because I cannot be held responsible for the words that come out of my mouth when I’m doing this online paperwork.”

For those who are not native English speakers, the process is far more complicated, said Eva Castillo of the New Hampshire Alliance of Immigrants and Refugees. She learned that when she and her husband applied for Medicaid benefits for their son. The statewide helpline 211 is a good place to start for most, but language barriers remain, Castillo said. “You really have to fight to get people to give you the information that should be out there available for everyone.”

The report released Tuesday made several recommendations for lawmakers and state agencies. Staff should be well-trained and be able to explain the application process clearly, it said. Documents should be written in plain language and “navigators” could guide applicants as they gather documentation and complete forms. People who don’t have easy access to financial records could “self-attest” when applying and follow up later with documentation, the report suggested.

Other suggestions included a real-time eligibility determination process while a person is filling out an application and alerting applicants of any missing documentation when they submit their application, not weeks later. 

A new report from Rights & Democracy and The Center for Public Democracy found long wait times, confusing websites, and stigma were barriers for Granite Staters applying for Medicaid. (Source: “Sick of Waiting: Barriers to Medicaid Keep Healthcare Out of Reach”)

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Annmarie Timmins
Annmarie Timmins

Senior reporter Annmarie Timmins is a New Hampshire native who covered state government, courts, and social justice issues for the Concord Monitor for 25 years. During her time with the Monitor, she won a Nieman Fellowship to study journalism and mental health courts at Harvard for a year. She has taught journalism at the University of New Hampshire and writing at the Nackey S. Loeb School of Communications.