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Medicaid and Its Role in Providing Relief During Natural Disasters

As we know by now, Hurricane Harvey made landfall in Texas and has expended utter disaster. It is the first hurricane to hit the state since Hurricane Ike in 2008. My prayers go out to all the Americans adversely affected by Hurricane Harvey. It is an utter catastrophe. Living in North Carolina, I am no stranger to hurricanes. But it made me think…when people lose everything to a natural disaster, do they become eligible for Medicaid? How does Medicaid offer relief during and after a natural disaster.

Medicaid is imperative during natural disasters because of its financial structure – the federal government pays a large percentage of its funds, without any limit. So if Texas spends more on Medicaid, the federal government spends more on Texas Medicaid. Obviously, if caps were applied to Medicaid, this would no longer be true. But, for now, the federal government’s promise to pay a percentage without a cap is key to natural disasters.

When disaster strikes, Medicaid serves as a valuable tool to quickly enroll affected people in temporary or permanent health care coverage and to allow for rapid access to medical care, including mental health services.

Two of the most infamous disasters, at least in recent US history, are the 9/11 World Trade Center attacks and Hurricane Katrina (now we can add Hurricane Harvey to the list). In both catastrophic events, people lost their homes, their businesses, suffered severe mental and physical anguish, and were in prompt need of health care. But applying for and receiving Medicaid is a voluminous, lengthy, and tedious process. And BTW, because of the natural disasters, no one has financial records to prove eligibility. Or, better yet, people were not eligible for Medicaid until the natural disaster. In that case, how do you prove eligibility for Medicaid? Take a selfie in front of where your house used to be? These are real issues with which survivors of natural disasters must grapple.

At the time of the 2001 attacks, New York already was facing a grave health care coverage quandary. Before 9/11, an estimated 1.6 million New Yorkers did not have health insurance. To apply for Medicaid, a person had to fill out an 8-page application, undergo a resource test and multiple requirements to document income and assets. Interestingly, in the case of 9/11, the terrorist attacks caused New York to lose its ability for people to electronically apply for Medicaid. But without the need of Congressional action, then-Governor Pataki announced that, low income residents would receive Medicaid by filling out a very short (one-page) questionnaire. Almost no documents were required. And coverage began immediately. Medicaid paid for over $670 million in post-9/11 health care costs.

In the case of Katrina, Louisiana straightaway stationed Medicaid employees at the FEMA shelters to enroll people in Medicaid. Louisiana also amended the Medicaid rules and allowed out-of-state providers to render services without prior authorization. Evacuees fled from Louisiana to surrounding states, and the evacuees, in many instances, had medical needs. Hundreds upon thousands of evacuees sought to use Medicaid and SCHIP to support their health needs in states in in which they were not a resident; however, four primary issues emerged. First, individuals eligible for Medicaid and SCHIP in their “Home” states needed to be eligible for and enroll in the “Host” state programs to receive assistance. Second, many individuals were newly uninsured and need to apply for Medicaid. Third, without Medicaid and SCHIP reimbursement, providers in the “Host” states could not be compensated for care provided to evacuees. Finally, because Medicaid and SCHIP are federal-state matching programs, “Host” states faced increased costs from enrolling evacuees. The Center for Medicare and Medicaid Services (CMS) approved, on an expedited basis, 17 Waivers to allow survivors of Hurricane Katrina to receive health care via Medicaid in approximately 15 states.

We can expect similar outcomes in Texas in the wake of Hurricane Harvey. HHS Secretary Price stated in an interview, “HHS is taking the necessary measures and has mobilized the resources to provide immediate assistance to those affected by Hurricane Harvey. We recognize the gravity of the situation in Texas, and the declaration of a public health emergency will provide additional flexibility and authority to help those who have been impacted by the storm.”

HHS has already deployed approximately 550 personnel to affected areas to help state and local authorities respond to communities’ medical needs, and additional staff is on standby to assist, if needed.

Our thoughts and prayers are with all those affected by Hurricane Harvey.

Government Shutdown: No Medicaid Funds Available in D.C., So Why Am I Still Getting My Mail!

Hey, have you heard??? Our federal government has shut down. So why am I still getting mail???

Unless you have lived under a rock for the past couple weeks, you are aware that our esteemed federal government has shut down.  At least…partially.  I keep getting mail.  Social security is still getting paid.  But don’t you dare try to visit a national monument…those are off-limits!! Really? Who decided what gets shut down and what stays open?  How is it that I still get my cable bill, but cannot visit Yellowstone National Park??

How is all this tomfoolery affecting Medicaid?  Minimally, in most areas, but Medicaid fundings HAS STOPPED in Washington D.C.

Why stop Medicaid funding in D.C. when the federal air traffic controllers are still working.  The State Department continues processing foreign applications for visas and U.S. applications for passports.  The federal courts are open.  The National Weather Service is still working.  Student loans are still getting paid. The Veterans’ hospitals are all up and running.  The military is still working.  I guess, Obama and White House staff are still working. (Although Obama could be on the golf course).  The Post Office is delivering mail.

Yet, here are some random federal actions and agencies that are actually stopped/closed:  Food safety inspections are suspended; U.S. food inspections abroad have also been stopped.  Auto recalls and investigations of safety defects are stopped.  Taxpayers, who filed for an extension in the spring, still have to pay their taxes by today, yet the IRS is not processing tax returns (How does this make sense??). The Consumer Product Safety Commission (CSPC) is not working.  (Great, after the CPSC starts working again, there are sure to be numerous lawsuits based on new product defects that have been placed in the market over the last 2 weeks).  The Environmental Protection Agency (EPA) has ceased to run, which means we have two weeks of allowable pollution.  Many at the Federal Bureau of Investigations (FBI) and the federal housing agency are furloughed.

How does this shutdown make any sense?? Who determined that the IRS should not process tax returns, but should accept taxes?  Who decided that safety inspections should be stopped, but passports should still be processed?

That safety inspections of food and products should halt, but students should still get federal loans.

Where is the logic?

It is as if someone said, “Shutdown the federal government!! Except not the mail, passports, and the weather service…keep those running!”

And then Medicaid in D.C…. Why did Medicaid funding stop only in D.C.??  While I still think if the mail is being delivered that D.C. providers could get Medicaid fundings, I will attempt to explain the illogical reason below:

Because D.C. is not a state.  D.C. is a local government without a state, so its budget must be authorized by U.S. Congress.  And Congress has not passed a budget.

D.C. has $2.7 billion budgeted for Medicaid, but providers are getting nothing (and, quite possibly, some recipients).  I can only imagine how this is negatively impacting health care providers in D.C. I am sure many of the providers are still rendering services unpaid.  But some, I would imagine, are closing up shop.  I know I could not last financially without a paycheck for 3 months.  I am sure many of the D.C. providers are no different.

But it still makes no sense.  Just like NC, D.C. pays for about 30% of Medicaid with the federal government reimbursing about 70%.  If NC’s federal reimbursements are still being paid, why not in D.C.?

And why am I still getting mail????

Well, my heart goes out to all the Medicaid providers and Medicaid recipients in D.C.  I hope you receive Medicaid fundings very soon.

Although, at least D.C. providers know that, at some point, the Medicaid funds will be funded; whereas in NC we still have NCTracks.