‘These are not good numbers’: Thousands more Mississippians, kids dropped from Medicaid
More than 16,000 Mississippians were dropped from Medicaid in August during the latest round of the agency’s disenrollments.
The pandemic-era federal regulations that prevented state Medicaid agencies from disenrolling beneficiaries ended in May. Since then, Medicaid divisions all over the country are reviewing their rolls for the first time in three years.
August’s numbers bring the agency’s total number of disenrollments thus far to 68,626 people. Before unwinding began, the agency’s enrollment exceeded 900,000 people for the first time in the agency’s history.
Most concerningly, most of those who were disenrolled — 54,366 people or 79% — have not been kicked off because they’re ineligible. Instead, there were issues with their paperwork – it was either not turned in on time or was incomplete. That could mean some people have been kicked off Medicaid even though they’re still eligible.
It’s unknown how many of the procedural disenrollments have been children. Children are most at risk of losing benefits during the unwinding process, federal research predicts, and many of them may still be eligible. Kids in low-income families comprise more than half of Mississippi’s overall Medicaid beneficiaries.
“These are not good numbers,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “It’s very concerning to see … people, likely children and parents by and large, losing Medicaid for red tape or procedural reasons.”
Mississippi Today has requested to interview an agency official about the unwinding data, but the requests were not granted.
New enrollment numbers show that from July to August, another 12,882 children were dropped, bringing the agency’s total of children dropped since unwinding began to 31,592.
Mississippi Medicaid’s monthly unwinding reports do not say what number of terminations were children, but Mississippi Medicaid spokesperson Matt Westerfield confirmed that most of these disenrollments are due to unwinding.
The agency’s ex-parte rate, or automatic renewal rate, remains low. Westerfield previously told Mississippi Today that the agency wants to increase those rates, but August numbers show that of the 70,069 people up for renewal, only 10,817 were renewed on an ex-parte basis.
That’s on par with the previous data release, which shows that of the 75,110 people up for renewal in July, 12,188 were renewed ex-parte.
The agency in August requested permission from the Centers for Medicare and Medicaid Services for “four additional flexibilities that would reduce procedural disenrollments while increasing ex-parte renewals.” According to Westerfield, some were approved, while discussions continue about the others.
The agency’s backlog of beneficiaries to review also keeps growing. In June, about 5,000 renewals were not reviewed. About 15,000 additional reviews went uncompleted in July and another 10,000 in August.
As unwinding continues for the next several months, the burden on the state’s already crumbling health care infrastructure grows. One report puts nearly a half of the state’s rural hospitals at risk of closure.
State Republican leaders have adamantly opposed expanding Medicaid to the working poor, which research shows would bring in billions, though presumptive incoming House Speaker Jason White recently indicated he would consider expansion. His predecessor Philip Gunn largely led the effort to oppose the policy change.
Man gets two years in prison for using Covid-19 relief funds to start alpaca farm in Vermont
A former Massachusetts pizzeria owner has been sentenced to two years in federal prison for fraudulently using more than $600,000 in pandemic relief loans for personal expenditures, including founding an alpaca farm in Vermont.
Dana L. McIntyre, 59, now living in Grafton, Vermont, and previously of Beverly and Essex, Massachusetts, was sentenced Wednesday in U.S. District Court in Boston.
Judge Denise J. Casper ordered McIntyre to serve two years in prison and three years of supervised release, according to a press release from the U.S. Attorney’s Office in Massachusetts. The judge also ordered McIntyre to pay $679,156 in restitution.
McIntyre’s attorney argued for a lesser sentence of one year, court records show. He had earlier pleaded guilty in April to four counts of wire fraud and three counts of money laundering.
According to federal prosecutors, in March 2020, at the start of the Covid-19 pandemic, McIntyre used the names of two of his adult children to file false applications to the U.S. Small Business Administration for loans for businesses that did not exist.
Prosecutors also charged McIntyre with misrepresenting information about a pizza shop he owned in Beverly, Massachusetts, in a federal Paycheck Protection Program loan application in April 2020, claiming to have almost 50 employees when there were actually fewer than 10.
The Paycheck Protection Program was created by Congress to help businesses retain employees during the pandemic.
Charging documents stated that McIntyre sold the Rasta Pasta Pizzeria after receiving the $660,000 loan. He then used the money to buy the farm in Vermont and eight alpacas, the court records show.
McIntyre also used the funds for other personal expenses, including buying two vehicles and airtime for a radio show focused on cryptocurrency, according to court documents.
Attempts to contact McIntyre by phone and email on Thursday were not successful.
The New York Times, in a story published Wednesday, reported that McIntyre opened the Houghtonville Farm in 2021, with its website stating that it offered people the chance to hand-feed and stroll with the animals at the property.
McIntyre told the New York Times that when he first bought the property he did not intend to turn it into a farm, saying he bought two alpacas as “lawn ornaments” but decided after the animals attracted attention to start up a business.
“It wasn’t this mastermind program to steal money from the government and go up and start this alpaca farm,” he told the New York Times. “No, it unfolded and it took on its own life form.”
The Covid-19 pandemic has brought lasting changes to Vermont’s theater companies
At Northern Stage in White River Junction, crew members look at the weather forecast every morning to figure out if, between heat and rain, they will be able to work outside. The outdoor stage first built to adapt to the Covid-19 pandemic has become a permanent part of the setup.
When a reporter visited, the crew was busy setting it all up for the opening of “Sense and Sensibility,” the play the company is performing until July 9. All the sets were built in house, but that may not happen again. For the next play, “Twelfth Night,” which opens Aug. 1, half the sets are being built on site and half are being built a three-hour drive away by Upstate Scenic, a company in Chatham, New York, that constructs sets for theater and film.
Next season, the theater company will work with the contractor to figure out what makes sense to build on site and what makes sense to contract out.
The company experimented with this approach in March, with its production of “Sweat,” and “it went extraordinarily well,” said Jason Smoller, Northern Stage’s managing director.
Northern Stage decided to outsource its set construction because space is tight and staff is hard to find, said Brian Sekinger, director of production. Upstate Scenic also works with Weston Theater Company and other local companies, he said
A lot of people, particularly in set construction, “pivoted to other careers” during the pandemic, Sekinger said. “They either went into more industrial construction or building houses or just sort of left and did something totally different.”
Set construction is just one of the ways that theater companies across Vermont have adapted in permanent ways to changes imposed by the pandemic. They have outsourced the work on sets, let theatergoers pick their ticket prices, and performed more outdoors in summer as they try to regain audiences that have yet to return to pre-pandemic numbers.
“The pandemic isn’t over,” said Cristina Alicea, managing creative director of Vermont Stage, which is based in Burlington but also produces a summer outdoor play at Isham Farm in Williston. “We’re still dealing with audiences not fully back yet.”
Reconstructing career pathways
Like Northern Stage, other companies have moved outdoors in summer.
Lyric Theatre Company in South Burlington adapted to outdoor plays for young audiences during the pandemic, and those have become part of the company’s regular programming, said Erin Evarts, the company’s executive director. In June, the company performed outside at three public libraries and at the Shelburne Museum.
Weston Theater Company also took its programming for children outside in 2021, and never went back. And, the company is also performing those plays in towns beyond its home.
“It’s now a free tour for audiences all over southern Vermont,” said Susanna Gellert, the company’s executive artistic director. The troupe perform for free outdoors in Grafton, Brownsville, Springfield and Rutland, transforming a show that used to reach about 800 people to one that reaches more than 4,000.
But the workers employed in the field of building those sets are fewer and farther between.
Sekinger said that, nationwide, about 30% of theater technicians went into other careers during the pandemic.
“So we’ve been starting to rebuild,” he said. “There just aren’t the same number of people that there were before.”
Early-career professionals, Sekinger said, did not get the same hands-on experience in college during the pandemic they would have before. For instance, they were not able to produce in person, on stage, because so much theater was on Zoom.
Between the shortage of experienced people and the lack of experience of new people, he said, the alternative to contracting work out would be to have staff members work 60 to 80 hours a week.
The housing shortage is another factor leading to a dearth of technical professionals, Sekinger said. To alleviate housing costs for its employees, Northern Stage has bought some properties in the area and leased others, he said.
“During the pandemic, everybody moved up from New York, bought up all the housing and sort of stayed, which means there isn’t as much housing in the area for new people coming into the organization,” he said.
Smoller concurs: “It is becoming increasingly difficult to hire. It all comes down to housing.”
Weston Theater has taken another direction toward lowering housing costs for members of the company, at least in summer. It has formed a partnership with a company that in winter houses staff at Okemo Mountain Resort in Ludlow. That housing was not being used in summer, so Weston Theater is renting it.
While outsourcing set construction, Sekinger said Northern Stage retains creative control over those sets.
“We just send them drawings and paint renderings and research images and say: ‘This is how we want it to look,’” he said. “And then it just shows up here.”
Josh Davis, Northern Stage’s technical director, goes to the shop in New York to make sure that it is building what was drawn, and to answer questions.
“And making sure that if they’re supposed to be painting something blue and we’re building something blue and those blue things touch each other, then it’s the same color blue,” Sekinger said.
It’s a pretty significant shift in the industry right now, Sekinger said, for small regional theaters to acknowledge they cannot staff up the way they would pre-pandemic.
Sekinger said Northern Stage is adapting in other ways because materials are hard to get or cost more than they used to. He points to the painted plywood made to look like tiles on the floor of the outdoor stage set.
“We do a lot of painting wood to look like other other materials because it’s cheaper or easier to get wood than it is to get some of those other materials,” he said.
Another adaptation, Smoller said, is that Northern Stage is paying closer attention to what its audience wants. That change came about after the company staged “Spring Awakening” last year. The musical is about loss of innocence, abortion and teenage suicide.
“And the feedback we heard from people was it is just too difficult and too sad for this moment,” Smoller said. “So we thought oh, no, we can’t do sad plays anymore.”
Smoller said the company’s artistic director, Carol Dunne, considered pulling the next play, “Sweat,” but the company, proud to put the play on, decided to go ahead. The play deals with hard social issues, such as loss of jobs, poverty and addiction.
“This play deals with real issues, too,” said Smoller. “It is not about teen suicide, which is very difficult to grapple with.”
Smoller said it was universally well received.
“Our audiences loved it,” he said. “So many folks told us: ‘That is the best thing I have seen at Northern Stage.’”
The response reaffirmed that the company’s audiences still want challenging theater.
“They don’t want sad theater, necessarily, but it’s not that they just want to see ‘The Little Mermaid’ or ‘A Christmas Carol’ again,” Smoller said. “So what has changed for us permanently is we are really conscious of what people are looking for, and the season we are offering next season doesn’t have any ‘sad’ titles.”
That said, Smoller said, some people do want “A Christmas Carol,” and Northern Stage will offer a new adaptation of the play this year.
A push toward youth
If the pandemic led adults to avoid depressing plays, Smoller said young people are just looking for more in-person connection and belonging after years on Zoom, and so he is seeing increasing interest in the company’s intensive youth ensemble studios.
The studios offer students an opportunity to learn on the stage of a professional theater company, with professional actors, designers and directors.
In addition, he said, high school students are looking for inclusivity and belonging, and are drawn to theater by virtue of the fact that it is not closely associated with a particular gender.
“We don’t run a men’s lacrosse team,” he said. ”Even in high school, students who are grappling with their identity have to choose: ‘OK, if I’m going to be on the swim team, it’s the boys’ swim team or the girls’ swim team.’ And theater isn’t that. You never have to opt into one or the other.”
Teens tell him they find an inclusive place at Northern Stage, he said.
What does a ticket cost?
Another change brought about by the pandemic: Audiences are buying tickets at the last minute, said Evarts, at the Lyric Theater. She said the national trend is that tickets are being bought in the last week to 10 days before a show, and the Lyric is finding that, as well.
Alicea said Vermont Stage also contends with waiting for last-minute ticket purchases.
Last year, Weston Theater brought in another big change. Having trouble persuading people to buy subscriptions, it started letting patrons pick the price they want to pay for one. The company offered three prices for exactly the same seats. As a result, Gellert said, subscriptions doubled last year, and this year, the company had already sold more subscriptions before the season started than it did during the entire year last year.
This year, Weston Theater is also letting people pay what they will for previews — performances before a show is reviewed.
“You can choose to pay zero,” said Gellert.
Last year, Vermont Stage found that subscriptions dropped by half, and “I’m finding that a lot of people are still hesitant to sign up for a full year,” said Alicea. She believes the experience of the pandemic is leading people to wait and see before making long-term commitments.
“My hope is that people don’t wait and see too long, because it could spell trouble for our organization and others,” said Alicea.
This year, Vermont Stage, too, is letting people pay what they will for both subscriptions and individual performances. The company is letting patrons pay one of three prices — $24, $44 or $64 — for a general admission ticket. If people pay $64, they are helping to subsidize the people who pay $24, said Alicea.
The company also offers three prices for subscriptions, with the same number of shows for each and also for general admission: $89, $149 and $209.
Based on early sales of subscriptions, most people are paying $149, Alicea said, which is what she assumed would happen. But the company thought the second-largest group would be people who paid $89, and that has not turned out to be the case. Instead, more people are buying at the $209 price, a sign that patrons want to support the organization, she said.
“They’re definitely showing up for us in that way,” Alicea said. “It’s deeply appreciated.”
Alicea said she was inspired to offer the pick-your-price model by Andy Butterfield, the marketing director at Weston Theater. Sharing information about what works is how theater companies hope to rebuild their field, she said.
Hundreds lose Wyoming Medicaid and Kid Care coverage
More than 450 people have so far lost health coverage through Wyoming Medicaid or Kid Care CHIP as the state moves away from pandemic-era measures, the state health department reported at the end of June. Thousands more are expected to lose coverage over the next nine months.
The largest factors in losing eligibility were age, residency and income, according to Wyoming Department of Health spokesperson Kim Deti.
The health department has estimated that between 10,000 and 15,000 residents could lose access to Medicaid programs this year as it conducts a yearlong renewal process. Some free medical clinics expect the increase in uninsured residents to further strain resources.
That annual process was put on hold during the pandemic to ensure coverage for more people in exchange for a temporary increase in federal funding. Starting in April, Wyoming health officials began removing people who no longer qualify, but a more complete picture of these “procedural removals” is expected to come out next month.
Early reports from Montana show more than 70% of those at risk of losing coverage simply didn’t provide requested information to health officials.
Wyoming’s health department started updating people’s contact details back in March, the agency stated, to make sure those who are still eligible get the renewal notice.
“Because of the pause, our clients have not received these notices by mail over the last three years,” Lee Grossman, state Medicaid agent and senior WDH administrator, said in a March press release. “We know living situations may have changed during that time for many people.”
Income has been one of the largest factors in losing eligibility so far, but thousands of Wyomingites already fall into a “gap” where they make too much to qualify for Medicaid in the state but too little to afford private insurance. To shore up this gap, 41 states have expanded Medicaid, but Wyoming lawmakers have yet to do so, often citing concerns that the federal government won’t hold up its end of the bargain to help pay for it.
The state estimates Medicaid expansion would insure about 19,000 people over two years.
To ensure they get a renewal notice, Wyoming Medicaid enrollees can update their contact information at www.wesystem.wyo.gov or by calling 1-855-294-2127.
Youth Soccer returns to Breckenridge after three-year hiatus
As NC begins Medicaid ‘unwinding,’ federal official warns of worrying trends
By Jaymie Baxley
North Carolina is in the process of reviewing Medicaid eligibility for more than 2.9 million residents amid the unwinding of a federal mandate that prevented states from kicking people off the rolls during the COVID-19 pandemic.
Known as the continuous coverage requirement, the mandate created by Congress in early 2020 protected Medicaid beneficiaries from losing coverage even if they no longer qualified for the program. It expired in April with the end of the public health emergency, allowing states to disenroll residents for the first time in nearly three years.
Terminations are not set to begin until July in North Carolina, but a top Medicaid official for the Biden administration has noticed a concerning trend among states that are further along in the process.
He said a lot of the people losing coverage was because of “procedural red tape,” rather than being over the income limits that determine eligibility. The issue is compounded by a lack of public awareness, according to Tsai. He said many at-risk enrollees do not know about the unwinding and the effect it could have on their benefits.
“I would anticipate when terminations actually start, then you’re going to start to see a bunch of folks realizing for the first time that this is happening,” he said. “That’s of concern to all of us, and we really want to make sure that people get the word out.”
While the criteria for Medicaid varies from place to place, most states use the federal poverty level as a baseline for eligibility. This means the people at greatest risk of losing coverage should be those with incomes that now exceed the limit for their state, which in North Carolina is $24,860 in annual earnings for a family of three.
Several states are reporting worryingly high rates of terminations for what are essentially paperwork issues. A recent study by KFF, formerly known as Kaiser Family Foundation, found that more than 80 percent of unwinding-related terminations in Arkansas, Florida, Indiana and West Virginia involved residents who “did not complete the enrollment process and may or may not still be eligible for Medicaid.”
“Millions of Americans’ health insurance and health care coverage is really at risk,” Tsai said. “We are urging every state across the country to do more and to take up many of the strategies we have put out on the table from a federal standpoint that really help make it easier for eligible people to stay covered.”
One strategy the Biden administration is promoting, Tsai said, is automatically renewing coverage for people who continue to qualify for Medicaid. According to North Carolina’s unwinding plan, the state hopes to complete most renewals “without any contact with the beneficiary” using information collected from wage databases and other sources.
Still, there will be cases where the state does not have all the information needed to confirm a Medicaid recipient’s eligibility and must reach out to the person by mail. If that beneficiary fails to respond within 30 days, their coverage could be terminated.
“One of the really important messages for people is to not only update their contact information, but return the mail,” Tsai said.
Before the pandemic, Medicaid participants typically underwent annual or semiannual reviews to verify that they continued to qualify for coverage. But people who were added to the rolls while the federal mandate was in place have never gone through that process. Statewide enrollment grew 36 percent during the pandemic, with over 797,000 people newly qualifying for coverage from March 2020 until April of this year.
“What we find is a lot of people have no idea that Medicaid renewals have started,” Tsai said. “Consumers were told for three years, ‘Don’t worry, your Medicaid coverage is protected.’
“All of a sudden federal law has changed. A renewal form comes but the average consumer doesn’t know what Congress has done and doesn’t even know they need to respond to something.”
In a statement to NC Health News, the N.C. Department of Health and Human Services said 300,000 people are expected to lose coverage over the next 12 months. The agency says it is working to “ensure people eligible for Medicaid do not lose coverage and those no longer eligible are transitioned smoothly to affordable health plans.”
People ordinarily have only 60 days to enroll in a marketplace plan after losing Medicaid, but CMS has created a special enrollment period for individuals affected by the unwinding. They can apply for marketplace coverage at any time through June 31, 2024.
The timing of the unwinding presents a unique challenge for North Carolina, which is set to become the 40th state to expand access to Medicaid.
Medicaid expansion was signed into law by Gov. Roy Cooper mere days before the continuous coverage mandate expired. It is expected to benefit hundreds of thousands of North Carolinians with incomes that are less than 138 percent of the federal poverty level for their family size — $34,306 for a family of three — up from the state’s previous limit of 100 percent.
DHHS has confirmed that many residents who lose coverage during the unwinding will become eligible again once expansion officially goes into effect, likely this summer. That won’t happen until a state budget is approved, which still could be months away.
“When you start renewals with expansion still to come and you’ve got a gap, it just leads to people having a gap in coverage and some confusion and resource challenges,” Tsai said. “Hopefully folks will have every chance in North Carolina to, if they’re eligible for Medicaid expansion when that starts, be able to seamlessly transition into that.
“And of course, if they’re not eligible for Medicaid, we want to make sure they’re getting over to other forms of coverage.”
WINDOW ROCK, Arizona — Navajo Nation President Buu Van Nygren was not coy about his intention to lift the COVID-19 mask mandates on the Navajo Nation once elected. This was one of his campaign promises that he made for his first 100 days. He’s kept that promise.
On Friday, Nygren signed an order that lifted the last of the COVID-19 restrictions that mandated masks be worn in schools, healthcare facilities and assisted-living homes.
“It’s an exciting time because it just shows that as president, I believe in our people at the local level, as well as really trying to empower them,” Nygren told ICT.
This decision was not made hastily. Since taking office the Nygren administration has been getting feedback from these facilities and institutions on what they wanted when it came to the Navajo Nation health mandates. According to Nygren, they wanted to have autonomy over their own policy and procedures.
“The schools, majority of them, wanted to lift it because it’s so hard to require the students to wear them in class, to go to school, all the write ups, and it was just really tough on the administrators,” Nygren said. “But as far as assisted-living facilities, that’s up to them. I know they run their own facilities. Health care facilities, that’s up to them.”
In January, Nygren lifted the general public indoor mask mandate with the exception of health care facilities, assisted living facilities and schools.
Beginning in spring of 2020, the Navajo Nation quickly sent workers home, shuttered offices and non-essential businesses, mandated masks, closed its borders to visitors and enacted curfews. This was in an attempt to limit the spread of the COVID-19 virus.
The nation became a hotspot for coronavirus cases and deaths over the course of the pandemic.
Approximately 170,000 people who live on the Navajo Nation, according to the U.S. Census. The Navajo Department of Health reported nearly 84,000 confirmed COVID-19 cases as of May 5, 2023. The nation also reported 2,117 deaths.
The pandemic worldwide has claimed nearly 7 million lives in the last three years, according to the World Health Organization.
On Friday, the World Health Organization determined that the COVID-19 pandemic was no longer a global health emergency, saying the virus has been on a downward trend for the last year. The United States is set to let its health emergency order end on May 11.
“I think I’d be so hesitant if the Navajo Nation was the first organization to reopen,” Nygren said. “I’d be very hesitant but a lot of entities around the Navajo Nation have been reopened, some of them, over a year now, some of them into the months. We’re just playing catch up at the moment.”
Cabinet member Rhonda Tuni, and head of the Navajo Department of Health, supports the removal of the final mask mandates on the nation.
“We are very excited to finally lift the mask mandate all across the Navajo Nation,” Tuni said. “Continue to practice the guidelines, hand sanitizing, and anything else that you’ve learned throughout these last three years.”
As the school year winds down, the mask mandate for next year has been a topic of discussion for the public schools on the nation.
“We’re very thankful to President Nygren and his staff to not necessarily lifting the mask mandate but just making it an option for our families,” said Shannon Goodsell, superintendent of Window Rock Unified School District. “This provides an opportunity for all of our students, all of our moms across the Navajo Nation to make the best decision for their families in order to keep their children safe while they’re in our schools. On behalf of the public schools across the Navajo Nation, we would like to say thank you.”
Fort McDowell Yavapai Nation, Hopi Tribe, Pueblo of Zuni and White Mountain Apache Tribe are the handful of tribes that still have a mask mandate, according to the Arizona Department of Education.
Earlier this year, Nygren received backlash about his decision to lift the general mask mandate.
The response on Nygren’s Facebook live announcing the lift is mixed, some people agree but many do not.
“I’m not here to please everybody but I’m here to make decisions as president,” Nygren said. “I think that’s very important. You got to make decisions and move on.”