NEW YORK: Medicaid Enrollment Drops 26%
Medicaid enrollment in New York state has been declining since the 1996 reform of the welfare system, the New York Times reports. "In a trend that has alarmed health care providers," Medicaid enrollment dropped 26% between January 1995 and January 1998, according to analysts from the United Hospital Fund. However, state officials said the decline was closer to 17.5% due to growth in overlapping Medicaid categories such as those for disabled adults. In addition, the New York State Coalition of Prepaid Health Services Plans said "involuntary disenrollments" were 20% higher last year than in the previous year. Regardless, health providers contend the trend "reflects an emerging national pattern" of individuals being discouraged from applying for welfare and inadvertently being dropped from Medicaid rolls. The number of welfare recipients in New York has dropped by 547,000 since 1995 -- two-thirds of which are children. The Times reports that "4.5 million children in New York are eligible for Medicaid, but are not" currently enrolled in the program. Dr. Irwin Redlener, director of community pediatrics for Montefiore Medical Center, emphasizes that "[t]he very group that is eligible for Medicaid and not getting it are the kids who have the highest rates of asthma, anemia and every imaginable health care problem." Although some analysts contend that lower Medicaid enrollment reflects a stronger economy providing increased private insurance options from employers, others say "[m]any parents may not realize that their children probably are still eligible for Medicaid."
Jim Tallon, president of the United Hospital Fund, cites barriers in the access system as the reason for the declining numbers. He describes "demand suppression -- where people are simply not coming in the front door of the public assistance program because they perceive it not to be open to them." Tallon explains the administrative difficulty of pushing individuals away from welfare benefits while simultaneously encouraging them to retain Medicaid benefits. The Times notes that even key political figures outline the discrepancy between the public policy goals in New York. During his term, Gov. George Pataki (R) has been influential in pushing for a Medicaid expansion and the Child Health Plus program to extend health care benefits to uninsured children. In contrast, Mayor Rudolph Giuliani (R) has encouraged welfare programs to divert poor people from public assistance programs. Officials note that recipients dropped from welfare rolls, but still eligible for Medicaid, must apply in a separate Medicaid office in a process that "sometimes daunts even people with pressing medical needs." Individuals who lose welfare benefits automatically are dropped from Medicaid rolls within 30 days, unless they appear at the Medicaid office for a "redetermination" of their eligibility. Penny Schwartz, director of the Resource, Entitlement and Advocacy Program sponsored by Mt. Sinai Medical Center, challenges the program's effectiveness at recruiting those eligible. "Forget about user-friendly," she said, "We're talking about user-hostile."
The Times notes that the situation in New York may reflect national trends. Although national Medicaid figures since the 1996 welfare law was implemented are not available, Leighton Ku, an Urban Institute health policy analyst, notes that most state Medicaid directors hesitate to draw attention to the problem because "for the first time, Medicaid is not eating the budget." In addition, Ku noted that "Medicaid reform is sacrosanct in many states" (Bernstein, 8/17).