Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
Passive Renewals Helping Medicaid Redetermination Process
With Michigan’s post-pandemic Medicaid redetermination process well underway, the Department of Health and Human Services has stayed busy contacting Medicaid recipients to inform them of their redetermination requirement. But, in some cases, an automatic or passive renewal is easing DHHS’ workload.
Nicole Hudson, DHHS senior advisor on special projects, explained the redetermination process that started after three years of pandemic-prompted auto-renewals for Medicaid. It was accompanied by a significant increase in the state’s Medicaid population and an almost 35% increase in Michiganders on Medicaid.
Over 3.2 million Michiganders were covered by Medicaid in May 2023, Hudson said.
Starting in June, those Michiganders are being notified in monthly-grouped cohorts that their Medicaid is up for redetermination. They’re first sent a letter, then a packet in the mail, which is pre-populated with all information on file and must be completed within approximately 30-days to determine their continued eligibility.
Hudson said it can be returned as physical paperwork, completed via the state’s online system or called in via a renewal phone line, but is then processed through a caseworker. If information isn’t returned, DHHS will follow up and contact recipients by text, phone or email, she said.
Hudson said there has been a lot of flexibility through restarting redeterminations, including expanding the window for renewal by a month. This helps both beneficiaries, who could struggle to get the paperwork in, and DHHS, which can use the extra time to contact beneficiaries and send reminders.
“It allows our partners and our Medicaid health plans the same opportunity to do that outreach,” she said, adding that “We have seen some great uptick.”
Updated DHHS data shows that Medicaid redeterminations have been completed for 991,000 Michiganders, with a total of 337,000 renewed thus far.
An additional 294,000 were not renewed for procedural reasons, like not providing requested verification documents, and 61,000 people have been determined ineligible.
This process, which will continue through May 2024, has been a significant increase in workload for DHHS, though she said the department isn’t making any supplemental funding requests at this time.
“We increased the number of people we had and were prepared for the number of renewals that we were going to have to do, so I think the department was well positioned for the number of renewals that we were going to have to do,” Hudson said, “ . . . But it has certainly been a significant increase in workload and so, again, we’ve been taking a lot of opportunities and flexibilities that CMS provided to us.”
She said the biggest area DHHS has been trying to increase is ex parte, or passive renewals, which is when information already available in the system can be used to auto-renew Medicaid recipients.
That can be updated information sent in recently, along with income or asset information already available, she said.
If it’s recent enough, someone can be automatically renewed, and they receive a letter informing them that their Medicaid has been automatically renewed.
“That helps beneficiaries not have to return paperwork and packets,” she said, “and that also decreases the workload at the local office level as well.”
Through increased focus and training, Hudson said that DHHS has gotten ex parte renewals close to the 40 percent mark. DHHS data puts the number of Michiganders who’ve gotten ex parte renewals at a little under 330,000, or around 33 percent.
“But since it’s been a year since we’ve had a lot of connection with folks, there’s a lot of people who we end up not being able to do that for,” Hudson said.
In those cases, outreach and communication efforts, like radio ads, social media posts and partnerships with outreach organizations, have come in handy.
MedNetOne Health Solutions (MedNetOne) co-founder Ewa Matuszewski said her organization has partnered with the Salvation Army to follow its bed and bread trucks, or mobile soup kitchens, to provide direct outreach to those undergoing the redetermination project.
The pilot program, which launched Oct. 23, contacted an estimated 1,500 residents in one week.
Matuszewski said the program began in response to “huge gaps” in knowledge among those applying for redetermination, and her work with the Salvation Army has centered on explaining the process to those that are also requesting food assistance packages.
“We learned a lot from them, and they learned a lot from us,” she said.
Similar programs have since been held at a Mount Clemens community center and the Detroit Public Library, Matuszewski said.
She said it’s important to be sensitive, make sure the literacy levels of content are appropriate and provide information for those with non-English first languages.
“It’s important for us to be there to ensure that people don’t lose their Medicaid benefits, and it’s important for us to communicate to those individuals who may have moved and didn’t receive the redetermination packets that they should be seeking assistance immediately to see where they stand in that renewal process,” she said. “We don’t want to be put in a position every month to have to assist individuals in getting on the marketplace to purchase the product. Nor do we want to be working with individuals to have an appeal written to revert and to have that Medicaid turned back on for them.”
Nurse Reports A Stalker; Fired For Violating HIPPA
A legal tactic a former hospital nurse used, presumably to try to get her job back, unraveled today in the Michigan Supreme Court even though a couple of justices were sympathetic to her case.
Tammy McNeill–Marks was fired from the Gratiot County hospital for an unintentional HIPPA violation, and her legal team attempted to get around the mistake by claiming she’s protected by the state’s Whistleblower statute.
This legal argument fell apart at the Court of Appeals level and the Michigan Supreme Court declined to take up the case.
McNeill-Marks had a personal protection order (PPO) against Marcia Fields, the mother of a family member whose children McNeill-Marks had adopted. Fields apparently violated the PPO on a routine basis and, so, when Fields showed up at the hospital where McNeill-Marks worked, McNeill-Marks notified her attorney about the situation.
However, allegedly unbeknownst to McNeill-Marks, Fields was there as a patient. So, when the attorney’s processor showed up at the hospital with a fresh PPO, Fields was able to argue that the only way the attorney could have known she was at the hospital was if McNeill-Marks, an employee, told someone she was there.
The hospital was notified, and McNeill-Marks was fired.
McNeill-Marks tried to get her job back by claiming she was protected under the Whistleblower Protection Act and that her attorney was a “report.”
This didn’t fly at the Court of Appeals level because McNeill-Marks apparently told her attorney to “not tell anyone,” which the court ruled showed that McNeill-Marks didn’t mean to “report” anything.
Still, the Supreme Court justices had some commentary on the situation.
Justice Megan Cavanagh argued the nurse “engaged in protected activity” when she told her attorney that a patient had violated a personal protection order not to stalk her when she showed up at the plaintiff’s workplace. She argued the attorney is a “report,” under the Whistleblower Protection Act.
The appeals court also held that the State Bar of Michigan is a public body under the WPA – a question Justice Elizabeth Welch said she believes should have been answered.
“That important decision has never been reviewed by the full body of this Court,” she wrote.
Justice Richard Bernstein joined Cavanagh’s statement and Justice Brian Zahra joined Welch’s statement.