By Jazmin Orozco Rodriguez, KFF Health News
Abby Madore has a demanding job as a staff member at a community health center in Carson City, Nevada. Her main responsibility is assisting low-income residents in understanding their health insurance options, including Medicaid. Madore receives numerous phone calls from clients living in remote areas of the state seeking assistance. This year has been particularly challenging as states are working to manage their Medicaid programs after the end of a pandemic-era freeze on disenrollments.
Several navigator organizations in Nevada have been assigned the task of helping residents enroll in or maintain their Medicaid coverage. Madore primarily works with individuals residing in rural parts of the state, which covers a vast area of more than 90,000 square miles. As a navigator, Madore helps clients determine if they qualify for Medicaid or the Children’s Health Insurance Program (CHIP). If they don’t qualify, she assists them in finding a health plan on Nevada’s insurance marketplace.
Reaching people in rural areas has always been a challenge, according to Katie Charleson, a communications officer for Nevada’s state health marketplace. This issue is not unique to Nevada and raises concerns that limited resources will endanger rural Americans as the unwinding of Medicaid continues. Recent data submitted to the Centers for Medicare & Medicaid Services reveals that 72% of people who lost Medicaid coverage during the unwinding process were disenrolled for procedural reasons, rather than being deemed ineligible for the program.
Rural Medicaid recipients face additional barriers to renewing their coverage, such as longer distances to eligibility offices and limited internet access. Nationwide, Medicaid and CHIP covered a higher percentage of children and adults in small towns and rural areas compared to metropolitan counties. The researchers at the Georgetown University Center for Children and Families emphasize the importance of Medicaid to rural communities as it forms the backbone of their healthcare system.
The lack of access to navigators in rural areas could worsen the challenges faced by rural residents. Navigators play a crucial role in helping enrollees maintain their coverage or find alternative insurance options. Navigators are separate from call center staffers who assist with managing social service benefits. Unlike insurance brokers, navigators provide free services and unbiased guidance to consumers.
In Nevada, there are around 30 to 40 certified enrollment counselors working at navigator organizations to help consumers enroll in plans through Nevada Health Link. These organizations are mainly located in urban centers like Reno and Las Vegas, with only one group based in Carson City. Navigator availability and outreach strategies vary from state to state. For example, Montana, with a larger area than Nevada but a smaller population, has six navigators covering the entire state, including far-flung communities.
The unwinding of Medicaid presents new challenges for navigators in guiding individuals through complex insurance processes. A recent survey conducted by researchers at Georgetown University revealed concerning results. Former Medicaid enrollees searching for coverage on Google encountered aggressive and misleading marketing for limited-benefit products that do not adequately cover essential services or protect against costly healthcare expenses.
The federal government does not require states to break down Medicaid disenrollment data by county, making it difficult to track rural and urban concerns. The Center for Children and Families relies on Census Bureau data to differentiate between the two, but it is not available until next year. Monitoring call center statistics will be crucial as states continue the redetermination process. Rural areas heavily rely on call centers to renew their coverage.
Nevada’s call abandonment rate is a concerning statistic, with an average of 56% of calls dropping in May, the first month after the unwinding began. The Centers for Medicare & Medicaid Services expressed concerns about the wait time and abandonment rate impeding access to assistance and the ability to apply for or renew Medicaid and CHIP coverage by phone. Nevada had higher disenrollment and call abandonment rates compared to other states.
The challenges faced by navigators and the potential consequences for rural communities highlight the importance of addressing the issues surrounding Medicaid disenrollments. Efforts should be made to ensure that individuals receive the necessary assistance and access to healthcare coverage in an equitable and efficient manner.
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