Providers flag concerns about Medicaid infrastructure as ‘unwinding’ disenrolls thousands

As Hoosiers continue to be unenrolled from Medicaid following the end of the federal public health emergency, providers say they are concerned about the current Medicaid portal and infrastructure.

According to recent state data, about 53,000 Hoosiers were unenrolled from Medicaid last month. These numbers follow the end of the federal public health emergency.

During that emergency, Medicaid programs like the Children's Health Insurance Program and the Healthy Indiana Plan (HIP) temporarily suspended requirements for updated paperwork and documentation to remain eligible for coverage.

The emergency ended on April 1, leading to many Hoosiers being phased out of their coverage and having to move to marketplace insurance.

Heather Maritano is a licensed clinical social worker who provides some Medicaid care. She owns a private practice in Bloomington.

She said even prior to this unwinding, the state’s Medicaid portal has been confusing to navigate for providers and recipients.

“I'd like the portal to be updated so that if I do check something, I can be assured that it's actually accurate information,” Maritano said.

Maritano said the state’s initial Medicaid system about 30 years ago was easy to manage. However, she said there are now many confusing entities to navigate in order to provide Medicaid for patients.

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She said within the portal, there are several different managed care entities, or health insurance networks in addition to traditional Medicaid. Maritano said those who welcome patients with Medicaid must be credentialed under all of the different managed care entities. She said this can get confusing.

“There is supposed to be consistency across all of those managed care entities for how the services are and the policies and the reimbursement rates,” she said. “And there is not consistency. Within the lack of consistency, there's also false information and the portals are not up to date.”

Maritano said it has also been difficult for her to get reimbursed in a timely manner or get questions about this portal answered by state employees.

Additionally, she said this portal can cause confusion for Medicaid recipients and providers not being able to tell if someone is unenrolled from Medicaid coverage.

“It [the portal] says they have sessions, but they don't have sessions or they did have sessions, but it said they didn't,” Maritano said.

She said this uncertainty may lead to patients being phased off of Medicaid – pushing them into a jarring transition.

“We’ve had a few clients that have lost access to their health care,” she said. “And so that is problematic and there's nowhere for them to go. If you don't have health care, their treatment is not finished. It's not done.”

Maritano said she is concerned about the system’s future.

“We have an opioid crisis, we have a mental health crisis, we have a physical health crisis, and then we don't have any providers for services and we don't have any health care, even if there were providers because people have been pulled off of those systems,” she said. “There is no way to move forward.”

Maritano said she hopes to see a simpler and clearer Medicaid system and portal to help facilitate better transitions and communication about clients and their coverage.

If the unwinding of Medicaid coverage continues at the rate it is currently going, advocates say nearly 1 in 11 Hoosiers would lose their health care coverage by next year.

Violet is our daily news reporter. Contact her at vcomberwilen@wfyi.org or follow her on Twitter at @ComberWilen.