The Children's Aid Society

Perspectives on Disaster Relief Medicaid Transition

May 17, 2002

Kate Lawler, Program Director, Health Care Access Program (HCAP), Children's Aid Society

Testimony Before the New York City Council's Committees on Health, General Welfare, and Oversight and Investigation

Monday, April 29, 2002

I would first like to thank the City Council's Committees on Health, General Welfare, and Oversight and Investigation for holding this hearing and for giving me the opportunity to present the Children's Aid Society's perspective on the Disaster Relief Medicaid (DRM) transition.

In the days and weeks that followed September 11, commentators noted that we as a country had realigned many of our priorities to focus on what was truly important in life. Nowhere did I feel that change more dramatically than in the work my agency, the Children's Aid Society, does to assist New Yorkers in accessing public health insurance. Over the past 4 years, we have walked thousands of adults and children through the process it takes to get public health insurance in this state. For a few short months, we had the extraordinary experience of enrolling thousands of New Yorkers into Disaster Relief Medicaid. In doing so, we got a taste of a public health insurance system that set protecting low-income people's access to health care as a higher priority than scrutinizing the dates and dollars on their paystubs to make sure that no one living on $200/week got coverage if they were only eligible at $170/week.

I am deeply proud that New York was the site of what must be the single largest public health insurance enrollment effort in our nation's history. I have also been profoundly moved by the 379,000 people who came forward to apply. Whether they transition to ongoing coverage or not, their need for affordable health care will not go away. We all bore witness to that need in the lines of New York City residents that wrapped around Human Resources Administration (HRA) offices for months and we are all accountable to respond. I want to thank HRA for their leadership over the last 7 months and for including facilitated enrollment agencies in the Disaster Relief Medicaid enrollment and transition process. Community-based facilitated enrollment organizations enrolled over 25,000 people into DRM and we are now working to transition them into ongoing coverage.

For those of us who work on the front-lines of this city's public health insurance system, the Disaster Relief Medicaid transition means returning to business as usual. It means shifting our own focus from how quickly we can get people their insurance cards, and where they will get care, to whether the dates on their paystubs are consecutive and why windowed envelopes are not acceptable proof of their address. During DRM, we experienced a public health insurance system that was driven by its core mission of providing health care to those who otherwise cannot afford it. As soon as the program ended on January 31, we felt that core mission being buried under layer upon layer of complexity. Transitioning people from DRM to ongoing coverage means working through those layers of complexity that did not exist during DRM enrollment. I will briefly highlight 4 of those layers, contrasting them to the streamlined enrollment process of DRM:

1) Multi-faceted eligibility calculation: Much of the efficiency of DRM came from the streamlined eligibility calculation used to figure out whether or not a person was eligible. To transition people into ongoing coverage, enrollment staff will spend hours and hours navigating the multi-faceted twists and turns of eligibility calculations that sort people into the right program - Medicaid, Medicaid spend-down, or Family Health Plus. For example, for adults without children we will need to know if they pay for their own heat, and if so, whether it is natural gas, coal, wood, oil, kerosene, or propane so that we can use the right formula for calculating their allowable income.

2) Multi-page application form: To apply for DRM, people filled out a one page application form. To transition to ongoing coverage, they will answer a minimum of four pages of questions and in most cases additional pages to select a managed care plan or to provide information about absent parents or spouses. Medicaid eligible childless adults will need to answer a 10 question-form about their use of alcohol and drugs, with such questions as "Have you ever felt guilty about your drinking or drug use?"

3) Onerous documentation requirements: To apply for DRM, a person merely had to show a piece of ID. The application for ongoing coverage includes a 2 page checklist that requests documentation on every aspect of a person's life from birth certificates to burial agreements. The only documentation requirement mandated by federal law is that non-U.S. citizens document their immigration status.

4) Long waits from application to coverage: People who applied for DRM walked out of the Medicaid office with a piece of paper that gave them immediate access to the health services they need. Under normal circumstances, it takes months from the time people apply until they have an insurance card in hand. For example, a person applying for FHPlus will wait 2-4 months, if all the computer interfaces between HRA, Maximus and the plans line up smoothly. Any glitch along the way will result in even longer waits.

For 4 brief months, we all had relief from the complexity that usually entangles our public health insurance system. Resources normally spent wading through stacks of multi-page application forms were instead spent issuing insurance cards. Time usually spent discussing the finer points of pay stubs, tax returns, postmarked envelopes, and immigration papers was instead spent telling people where they could access care. Low income New Yorkers, usually turned away because their pay stubs were not consecutive or their utility bills too old, were instead given an insurance card and a list of pharmacies where they could get their blood pressure and asthma medication.

New York City is now far in front of the rest of the country in our understanding of what happens when barriers to public health coverage are removed. We are the only city that has directly witnessed the need for affordable health care as dramatically as we did through the DRM program. It is now incumbent upon us to use the wisdom we have gained as a city, to push our state toward a health care system that keeps its priorities in the right place and its resources invested only in what is truly needed to deliver affordable, quality care.

Thank you again for the opportunity to present testimony at this important hearing.

With the support of a grant from the New York State Department of Health, the Children's Aid Society leads a coalition of community-based facilitated enrollment organizations. Our coalition includes Asian Americans for Equality (AAFE), the Henry Street Settlement, the Chinese American Planning Council, and the Mount Sinai Adolescent Health Center. For more information about the Health Care Access Program (HCAP), call Kate Lawler at (212) 503-6801. If you would like to enroll in public health insurance, please call us at (212) 503-6804.