Code, Care & Consequence: Medicaid Changes are Happening. Are We Ready?
Melissa Fox, Acenda Integrated Health.
EDITOR’S NOTE: Front Runner New Jersey.com welcomes a new healthcare column by award-winning health executive Melissa Fox. Her monthly column will give your, our readers, fresh and important insight into the world of healthcare that affects you.
BY MELISSA FOX | MHA, FACMPE, FACHE
You can still have diabetes on the day you lose your Medicaid coverage.
Your blood pressure doesn’t suddenly stabilize just because you no longer have insurance. Your depression doesn’t take the month off. And the pharmacist doesn’t hand you your medication for free because there was a problem with your renewal.
You simply become uninsured. And that distinction is about to matter for a lot of people in New Jersey.
Beginning this fall, and more significantly in January, federal changes will affect how some New Jerseyans qualify for and keep their NJ FamilyCare coverage. Certain adults will face new work requirements. Many people will have to renew their coverage every six months instead of once a year, and significant changes affecting some non-citizens will begin even sooner.
There are exclusions and exceptions of course, and our state departments plan to verify as much information electronically as possible. But there’s a reality that anyone who has ever dealt with healthcare paperwork already understands: you don’t have to be ineligible to get lost in a complicated system. Sometimes all it takes is a missed letter, a new address, a form you thought you already completed, or a text you assumed was spam. Sometimes it could be an envelope you put on the kitchen counter and promised yourself you’d deal with later.
These are commonly referred to as “procedural” losses. And that’s an awfully cold word for losing your health insurance. But this is where technology can be leveraged even more.
We hear extraordinary claims every day about what artificial intelligence (AI) is going to do for healthcare like predict disease, discover new drugs, or streamline treatment. And I’m excited about many of those possibilities. But before we ask AI to reinvent medicine, I have a more basic challenge:
Can we better use technology to keep an eligible person from losing healthcare because we couldn’t reach them?
That may not make a great Silicon Valley pitch deck, but it could keep someone from spending the night in an emergency room. That means using technology to keep as many people as possible connected to care because New Jersey has a lot at stake.
State officials estimate that federal Medicaid changes could eventually result in more than 300,000 New Jersey residents losing NJ FamilyCare, although the actual number will depend substantially on implementation and how effectively people navigate the new requirements.
We should all care about that number. But, since I worry that with everything going on we’ve become immune to big numbers, I don’t want you to try and picture 300,000 people. I’m asking that you picture only one.
The one home health aide who manages her diabetes between caring for everyone else.
Or, the one father whose antidepressant makes it possible for him to get up and go to work.
Or the one woman whose mammogram found something that now needs follow-up.
Or, the one neighbor you wave to every morning who has never mentioned that his medication costs more than he can afford without insurance.
Their coverage might disappear. But their health needs won’t.
So, what do we do? Well, if you receive NJ FamilyCare, don’t panic. But don’t ignore this either.
Make sure your address and contact information are current. Open notices from NJ FamilyCare and if you’re asked for information respond.
Department of Human Services website to find out whether the new rules apply to you and remember that there are exclusions and exceptions—this is not simply a requirement that every adult on Medicaid must work. If someone you love receives NJ FamilyCare, ask them if they’ve gotten anything from NJ FamilyCare lately. That simple question can potentially save them a lot of trouble.
And those of us who lead healthcare and community organizations have to be sure we’re not thinking of Medicaid renewal as somebody else’s administrative problem. If the people we serve lose coverage, it will become our problem soon enough. We should be identifying who may be affected now, and updating their contact information at every opportunity.
Use data to determine who isn’t responding and leverage technology as needed for identification and outreach. And deploy people (not just more automated messages) when someone needs help.
This is also the reason for this column.
Every month, Code, Care & Consequence will look at the increasingly complicated relationship between healthcare and technology. I won’t be interested in only what the technology can do, but I want us to explore together who benefits and who doesn’t. We should explore what we may not have anticipated, and most importantly, what we should do about it. Together we’re going to ask the most pressing questions.
This is important to all of us because the future of healthcare isn’t going to be determined by technology alone. It’s going to be determined by what happens when that technology meets a real person on a very ordinary Tuesday who has a job to get to, a bill to pay, a prescription to fill, and an envelope sitting unopened on the kitchen counter.
That’s where code becomes care. And where care has consequences.
Until next time, stay curious.
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