Black churches work to blunt the impact of Medicaid unwinding on their communities

On a recent Saturday afternoon, drivers slowed down to peek at what was happening on the lawn of Broadway Church near downtown Indianapolis. There was a hotdog grill, face painting stations and an inflatable castle with exuberant children bouncing around to the tunes of the DJ.

It looked like a celebration, but right there, Rev. Shonda Nicole Gladden stood holding a microphone to deliver a more somber message.

“You could be at risk of losing your coverage,” she said loudly into the microphone, trying to invite people into the church. “If you or someone you know is on Medicaid, we need you to come down here right now. Learn more about the crisis. Get some help so you can help others.”

Gladden was part of an event that four Black churches in Indianapolis – with a grant from statewide health system Indiana University Health – have put together to try and blunt the impact of the Medicaid unwinding process on their communities and ensure people don’t lose their health insurance.

Millions of people across the country could lose their Medicaid coverage anytime now because states have, once again, resumed eligibility checks after pandemic-era federal protections expired. A Kaiser Family Foundation analysis estimates that between 17 and 24 million people nationwide could lose their Medicaid coverage over the next year.

States have been reaching out to Medicaid enrollees via different communication channels, including mail, text messages and pamphlets in health care settings. Still, a recent poll by KFF found that 65% of people nationwide on Medicaid did not know about the renewal process and the risk of losing coverage. Black Americans had the largest awareness gap.

In an ideal scenario, only those who are earning too much would be dropped off Medicaid. But national reports suggest that millions of people may slip through cracks if they’re unable to navigate the Medicaid red tape, even if they are still eligible for the low-income public health insurance.

That’s what’s been keeping Rev. Gladden up at night. She said many in her community have faced housing instability after losing jobs during the pandemic. Some might have changed addresses more than once over the past three years, and the government may not have this information.

“So, if they've moved, and they have a new address, they won't get the notification to say, ‘Hey, you need to do some additional things to make sure that you keep your benefits,’” she said.

Gladden said that people in her community are not always forthcoming about health and financial stressors and may not ask for help when they need it. So meeting people where they are with the information they need is crucial.

“Sometimes, particularly in the Black community, it's a little taboo to talk about things like this,” she said. “People aren't necessarily forthcoming. Even with me, as a pastor, they're not coming up saying I'm really stressed about this. But they will show up and just soak in the information.”

Those who answered Gladden’s plea in Indianapolis were led past the bouncy house down to the church’s basement where the action really was. Insurance brokers, Medicaid navigators, legal experts and medical staff had set up information tables for people to drop by and ask questions about their health insurance.

Concerning trend

Oishoma Ndubuaku was at one table in the church’s basement. She uses a walker because of her arthritis. She also has diabetes and some kidney problems. Medicaid helps cover many of her medical bills, and she’s terrified of losing coverage. She said Social Security would not be enough to cover her day-to-day basics.

“With what social security is paying…it cannot pay for my loan, for my rent and pay for any other thing,” Ndubuaku said.

She did not receive any mail or other forms of communication from the state about her Medicaid, she said.

One insurance broker tried to walk Ndubuaku through an online portal where she can track notices the state sends her and update her information. But Ndubuaku said she does not have a computer and can barely navigate the internet on her phone.

Ndubuaku is not alone. Her situation shows precisely why all hands must be on deck to guide people through a complicated process, said David Craig, a religious studies professor at Indiana University-Purdue University Indianapolis who studies the intersection of faith organizations and health care.

“We've got a five-alarm bell ringing here. And it's going to be ringing a lot louder a year from now because people are going to be losing their benefits,” said Craig.

That hypothetical bell has already started getting louder over the past two months as states have begun the redetermination process.

States are required to report monthly Medicaid redetermination numbers to the Centers for Medicaid and Medicare Services showing how many people were renewed or terminated and the reason behind the terminations.

The latest numbers from some states, including the Midwest states of Iowa, Ohio and Indiana, paint a concerning picture.

A KFF report on the latest Medicaid unwinding numbers show that of the 52,985 people who lost Medicaid coverage in Indiana, nearly 90% lost their coverage due to “procedural reasons,” That means they may have missed a deadline or the state hasn’t been able to contact them. In Iowa, of the 11,035 people who lost their Medicaid, 54% were terminated due to procedural reasons. And out of 46,057 who lost their Medicaid in Ohio, nearly 79% lost coverage due to procedural reasons.

“We need members to provide us information about their income, their household, and their personal situations,” Michele Holtkamp, spokesperson for the Indiana Family and Social Services Administration who handles the Medicaid unwinding process, said in an emailed statement.

She said the state is working to improve outreach to people in Indiana.

All hands on deck 

Public health experts have previously tried to piggyback on churches’ status to deliver public health messaging, like during the HIV crisis and the COVID pandemic to get more people vaccinated. There is a pressing need for community organizations like churches to step in now, said Jay Foster, the vice president of Spiritual Care, Chaplaincy Services and Congregational Partnerships at IU Health.

“In many communities, the congregation is a first place that people go for information about all kinds of issues, including about their health care,” said Foster, who leads IU Health’s collaboration with the Black churches.

The Medicaid unwinding process brings an unprecedented workload to state agencies trying to sort through millions of applications. This, combined with the fact that many people have never gone through the Medicaid renewal process, which was a routine part of enrollment before the pandemic, means the process is ripe for errors and unintended consequences.

“There's been some folks who have received notices that are blank and don't have a reason why their services are being terminated,” said Katie Whitley, a staff attorney with Indiana Legal Services who was at Broadway Church.

People use their insurance only when they have a medical need. This worries Whitely and her group, because it means many who end up losing their coverage may learn about it for the first time when they show up for a doctor’s appointment. This could lead to delays in treatment and necessary medical services until they appeal the decision or find other affordable insurance.

Whitely said community outreach like the event at Broadway Church will continue to be crucial throughout the year to help those who are eligible stay covered and those who lose their Medicaid find other coverage options promptly.

Indiana Public Broadcasting’s Violet Comber-Wilen contributed reporting.

This story comes from Side Effects Public Media — a health reporting collaboration based at WFYI in Indianapolis. Contact Farah at fyousry@wfyi.org. Follow on Twitter: @Farah_Yousrym

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