“My Papers Were Incomplete and It Kept Being Denied”: Challenges with the Medicaid Renewal Process
Lack of Information Available on Medicaid Renewal
Understanding the health insurance system in the United States can be a daunting task for anyone and is especially challenging for individuals whose first language is not English or who may be new to the healthcare system in the United States. Immigrants responding to our survey expressed that the New York State government was effective with informing individuals that they would have to go through a renewal but said there was not sufficient information about how to navigate the process. While 78 percent of survey respondents felt that the New York State government did well conducting outreach to inform enrollees that they would need to renew their Medicaid, many of these same individuals said they experienced challenges that made the enrollment process difficult and time-consuming.
The New York State Medicaid agency used multiple methods of outreach in an attempt to inform enrollees about the unwinding including, social media posts, television ads, mailed notices, and Medicaid updates. These methods achieved a significant degree of coverage, yet they did not work for everyone, especially individuals who moved and did not know how to update their address with the Medicaid office or who don’t have access to technology such a cellphones or televisions.
One survey respondent expressed that there was a “lack of information concerning the unwinding of Medicaid.” Another respondent pointed to a “lack of notifications and notices, especially regarding the required documents.” Similarly, another survey respondents noted the difficulties due to “lack of information concerning the renewal.”
Not being informed about how to navigate the renewal process can be detrimental to some individuals and families because it can cause them to lose coverage. A survey respondent said of their application that it cost their family extra money: “My papers were incomplete, and it kept being denied and I wasted extra money trying to figure out ways to go through it.”
When asked about what advice they have for others who are preparing to renew, an interviewee underscored that it is important to have information about the Medicaid program you wish to enroll in to help make the process easier: “…also have enough information about what you want to enroll in.”
Missing Notices from the Medicaid Office
While the state did send out notices that enrollees needed to renew their Medicaid, it did not always ensure people actually received those notices.
One respondent said: “I didn’t receive any notice to update or send documents regarding address change and incorrect contact info.” Another said that they had “no receipt of notice to send additional documents due to address change.”
More should have been done to reach out to individuals to ensure that addresses were up to date to ensure successful delivery of notices. Although most people did get the message, the consequences of not getting notices can be serious. One respondent explained “I didn’t receive any notices causing my subscription to be cancelled. I had to reapply,” and others might lose coverage altogether.
Lack of Clear Documentation Requirements
When asked what the hardest part of the renewal process was, many respondents said it was understanding and fulfilling the documentation requirements. A respondent highlighted the emotional toll that the process had taken on them when they noted that the most difficult part was the “lack of necessary documents and the stress undergone to accrue them.” Some individuals may have to get paperwork verified or notarized and obtain letters from former employers that may be difficult to get. Many survey respondents noted that “paper verification” or “document verification” was the most challenging part of the renewal process.
One interviewee also noted the emotional toll that the process can have. “I was pretty nervous,” one respondent said, “having this feeling that I was going to spend a lot and then sacrifice my time I would have used to work and all of that…and not being successful.”
When asked about what advice they would give another individual renewing their Medicaid, an interviewee highlighted the importance of having all the required documentation ahead of the renewal process: “The advice I can give them is to prepare. Prepare well, ensure they have proper documents before they enroll in Medicaid, because that really matters a lot.”
When an interviewee was asked how they would change the renewal process to make it easier for others they suggested that they would make resources for acquiring documentation available: “I would actually explain how to acquire documents. [I’d] make some resources explaining how to get the required documents for people who are eligible to renew Medicaid.” Another interviewee also felt that documentation requirements should be clearer: “it should be stated clearly, you know, on the requirement, so people would not be stranded in the process…this thing should be listed out boldly so that applicants get to see this before they make a step, so that in case they do not qualify for this, they wouldn’t have to waste their time trying to register.”
Medicaid Renewal is an Arduous Process
Many survey respondents noted that a challenging aspect of Medicaid renewal was the arduous process. Not only do enrollees have to obtain the correct documentation, but they also have to fill out long and confusing paperwork. This is challenging for immigrant New Yorkers because it has a lot of technical jargon and the enrollees first language may not be English.
A survey respondent noted that the process was made more difficult by Medicaid staff who continuously added new steps and requirements to their renewal which cost the respondent money and ultimately led to their denial: “The hardest part for me was the constant procrastination by the Medicaid office…Bringing in unnecessary steps each time I revisit just to screen me out and make me pay out of my pocket…it was so frustrating.”
A survey respondent highlighted that the most difficult aspect of the renewal process was “filling out the application” while another noted that “the steps of the whole process” was the most difficult while others noted that “the logistics” were the most challenging. An interviewee noted that filling out the paperwork was confusing because: “I could not understand the form, you know, the renewal form, which was sent to me…. I am actually renewing my Medicaid just for me, and it’s asking about other people in the household. So if I was actually renewing just for myself, I do not understand the part for the family, like the whole household…. What I’m saying is that the questions were just confusing at some point.”
Other interviewees also felt that some questions were irrelevant and only led to confusion. One interviewee noted that “some questions, I actually thought they were irrelevant.” When asked about what changes they would make to the process to make it easier for others, an interviewee suggested removing irrelevant questions: “I would just take out some [unneeded] questions because I feel some of the questions there are a waste of time.”
An interviewee noted that the renewal application was very long: “the only issue I had in that area was that it was just a lot, lots and lots of questions, like a truckload of questions.” Another interviewee noted that for them the hardest part was “the sheer amount of the time-consuming questions that were in the document.”
Another interviewee noted that the paperwork is so confusing that first-time enrollees would have a hard time understanding how to complete it and understanding the technical language used: “Taking a look at the form, if someone is actually doing this for the first time, … initially it’s going to be very confusing and you would actually get lost at some point. I remember [being] asked about assets, you know, savings accounts, retirement account and all of that. So if it is a person…looking at this form for the first time, [they might not know what “assets” refers to and] would definitely be confused.”
Long Wait Times for Assistance and Final Determination
Many survey respondents stressed the long wait times to receive assistance both in person and on the phone from the Medicaid Office. One person said waiting is the hardest part: “The renewal process was fairly easy. Getting a response seems to be the hard part. As noted, I’m still waiting.”
A survey respondent who called the Medicaid office highlighted how she waited on the phone “so long that I had to hang up.” When survey respondents were asked how long they had to wait in general to receive assistance from the Medicaid office, many respondents waited multiple days while others waited a week. Long wait times when enrollees need assistance make the renewal process more difficult and add stress due to being under short deadlines to complete and submit the application.
According to the survey, some respondents received their final determination in as short as a few days while a number had to wait up to 45 days. The survey revealed some instances where enrollees waited as long as seven months to a year.
An interviewee noted: “It’s just like, just over a week before they reached back to me.”
When asked how the renewal process can be improved, an interviewee suggested: “maybe the wait time when you call can be improved.”
Immigrant New Yorkers Turn to Others for Help with the Renewal Process
The survey revealed that many immigrant New Yorkers turn to trusted individuals to help them complete the difficult process. The survey found that 38 percent of respondents completed the application on their own, compared to 32 percent who received help from a staff member at a community-based organization, 25 percent from a family member and 6 percent had other help.
63 percent of Survey Respondents Turned to Help from Others with their Medicaid Renewal
Fig 1. Data from a survey conducted by the Immigration Research Initiative and based on 54 survey responses.
An interviewee expressed that they received help from friends in the medical field: “Yes, I got help from some of my friends who are medical personnel, so I got help from them. Somehow the process was actually not very clear to me, so I got help.” Another interviewee expressed that help from others is necessary because the technical and legal jargon can be confusing, especially if your first language is not English, and noted that a family member helped them complete the application: “we need help doing the form because even though you can read English…you might not be able to understand what is needed of you in terms of the legal terms. I was actually fortunate enough to have a cousin there with me to explain some of the words in the terms for me.” Not everyone has a family member that can do this, and it is not always appropriate for people to have to rely on family members, especially children, instead of Medicaid professionals.
Another interviewee acknowledged a community-based organization, the Pride Center of Staten Island, for their help with the Medicaid renewal application.
When asked about what advice they have for future enrollees, one interviewee noted that after completing the difficult process they would provide assistance to others to help them complete it as well: “I’ll just later give them a breakdown of the entire process. I would just, let them know that I’m always there to help them in case they needed my help, acquiring any sort of documents from the doctor, from the bank, any kind of help they needed.”