Almost no one attends Medicaid's workshops for beneficiaries. Advocates suspect Medicaid is fine with that.

by Isabelle Taft, Mississippi Today
October 27, 2022

SOUTHAVEN – Last week, staff from the Division of Medicaid and three managed care companies that serve Medicaid enrollees assembled at a public library in Southaven. Standing in a large meeting room in front of a dozen empty plastic chairs, they explained who Medicaid recipients can contact for transportation to appointments, how to get benefits like free produce, and how to access additional resources for dental and eye care.

But not a single Mississippi Medicaid enrollee was there to hear the presentation. 

Low attendance has been the rule at this year's workshops for beneficiaries – and advocates say that's because Medicaid has done too little to promote the events. They see a pattern of poor communication with enrollees that makes it harder for them to understand their benefits and access health care. 

In the coming months, that could have serious consequences for the 867,000 Mississippians now enrolled in Medicaid. When the federal public health emergency ends, potentially as early as January, Medicaid enrollees will lose coverage for the first time since March 2020 if they don't update their information to prove they are still eligible. 

Mississippi estimates that 14% of enrollees, or more than 121,000 people, will become ineligible. But people who remain eligible will also be kicked off the program if they don't know they need to update their information. 

Roy Mitchell, executive director of the Mississippi Health Advocacy Program, said the workshops would be a good opportunity to make sure people understand the coming changes and take steps to keep their coverage. 

But almost no one has attended the workshops, which were not promoted through direct mailings despite the use of that tool in the past.

“It's just presumed that if people know more about the programs, that the programs will work better,” Mitchell said. “And it's almost as if there's a deliberate attempt to hide the ball here. And people are frustrated. The beneficiaries are frustrated. The providers are frustrated.”

So far this year, the Division has hosted eight workshops around the state, including one in Meridian on Oct. 26. No one attended the workshops in Pascagoula on Sept. 20 and in Starkville on Aug. 25. One person attended the Corinth workshop on Aug. 18, and only a handful attended the events in Vicksburg and Greenwood, according to records obtained by Mississippi Today through a public records request. 

The largest number of attendees recorded at the in-person workshops was in Jackson, with 12. 

Only one person came to the Southaven workshop: A mom who had questions about unexplained recent changes to her daughters' coverage. She left after speaking with Medicaid staff, so a Mississippi Today reporter was the only person present for the presentation. 

Medicaid said it uses social media to promote the workshops, and it created a flier that was available on its website. But a Mississippi Today review of the agency's Facebook and Twitter accounts found the agency made only one Facebook post about the workshops before they kicked off. 

The agency's two tweets were both posted after six of the 10 workshops were already held – and after Mississippi Today sent records requests and questions seeking information about how they were being promoted. 

A tweet and Facebook post about the Southaven workshop were both posted just 90 minutes before it was set to begin.

By contrast, Medicaid posted on Facebook seven times in August, September and early October about workshops for providers to learn about Medicaid's new billing system. 

Medicaid officials also said they reached out to the Mississippi Head Start Association “and other community groups” to spread the word. The director of that organization told Mississippi Today she had no knowledge of Medicaid working with her group to promote the workshops.

When Mississippi Today followed up to ask about the discrepancy, Medicaid spokesman Matt Westerfield said they had misspoken and did not in fact reach out to the Mississippi Head Start Association this year. He said the managed care organizations shared information about the workshops with “a wide range of groups such as the Health Department, Goodwill and Salvation Army organizations, churches and school districts.”

Managed care staff at the Southaven workshop said that case managers promoted the workshops during conversations with members. The companies also promoted the workshops on their websites, at community events, and through emails to community partners like federally qualified health centers, according to documents Mississippi Today obtained through a records request. 

Staff at the Southaven workshop said they believed the COVID-19 pandemic led people to lose the habit of attending in-person events, and they anticipate attendance will be higher at two virtual workshops in November. 

The attendance figures are a sharp decline from 2019, the last pre-pandemic round of workshops, when a total of 307 beneficiaries attended 20 workshops across the state – an average of about 15 people per event. (Medicaid held twice as many workshops in 2019 as in other years because there was a new managed care Children's Health Insurance Plan provider that year.)

And they are an even steeper decline from 2018, when the Division sent a direct mailing to every beneficiary, letting them know when and where they could attend a workshop in their area.

That year, an average of 24 people attended each of the 10 workshops. The year before, average attendance was eight.

Westerfield said the agency did the mailing in 2018 to get the word out about a new managed care organization that had been added. The agency's “fiscal agent,” a contractor that assists with claims processing and payment, absorbed the cost of the mailing, but Medicaid paid $7,745.59 for postage, according to records Mississippi obtained through a request. 

“Over the years we've tried different avenues for reaching beneficiaries, and from what I understand the 2018 mailing wasn't as effective as we'd hoped,” Westerfield said, though the mailings were associated with a three-fold increase in average attendance.

Westerfield said that the agency has discussed trying mailings again in the future.

Joan Alker, executive director and co-founder of the Center for Children and Families (CCF) at Georgetown University and an expert on Medicaid, said state Medicaid agencies owe it to taxpayers to make sure enrollees are informed about their benefits. For people enrolled in managed care, the state pays a certain amount of money to the company every month, regardless of the services used. The money is wasted if people aren't using services because they don't fully understand their eligibility.

“It's extremely pennywise and pound foolish, to not be informing beneficiaries of this health insurance that's being bought for them with taxpayer dollars,” Alker said. 

Medicaid has acknowledged that its communications with beneficiaries during the public health emergency have sometimes been confusing. 

Mississippi Today previously reported that Medicaid told postpartum women they were losing their coverage 60 days after giving birth as usual during the public health emergency, even though that wasn't true. Medicaid then sent postpartum women a second letter later telling them they still had coverage during the COVID-19 pandemic, but several recipients told Mississippi Today they were confused – if they got the second letter at all – and delayed seeking care because they thought they would have to pay out of pocket. 

Medicaid has now paused the confusing letters, according to documents obtained by Mississippi Today.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.