ARI SHAPIRO, HOST:
During the pandemic, the number of Americans who got health coverage through Medicaid swelled. Now, states are required to check that every person is still eligible to stay on Medicaid. It is a huge bureaucratic task, and some people who do qualify have accidentally lost coverage. When that happens, it's particularly dangerous for unhoused people and hard to fix. Aaron Bolton of Montana Public Radio reports.
AARON BOLTON, BYLINE: At the homeless shelter in Kalispell, Mont., guests are getting ready for the day, eating breakfast or figuring out if the bus is running on time.
UNIDENTIFIED PERSON #1: If anybody needs food stamps or Medicaid, the lady is here.
BOLTON: Tashya Evans needs help getting back on Medicaid. She steps into a spare office with a local health care center worker.
TASHYA EVANS: Still having issues and stuff. So at this point, I'm just...
UNIDENTIFIED PERSON #2: Frustrated.
EVANS: ...Frustrated.
UNIDENTIFIED PERSON #2: OK.
BOLTON: Evans is among about 130,000 Montanans that have lost Medicaid coverage. Two-thirds of them lost it for technicalities like not filling out paperwork correctly.
UNIDENTIFIED PERSON #2: OK, Tashya. So tell me where we are.
EVANS: I tried to get online again. When you get to the first page, I hit submit, and it won't go past that.
BOLTON: Evans found out she lost coverage in September, but she never received renewal paperwork. That's forcing her to forgo her blood pressure medication and pause dental work.
EVANS: The teeth broke off. My gums hurt. You know, there's some times where I'm not feeling good. I don't want to eat.
BOLTON: She says staff at an assistance office were so swamped they didn't have time to help her fill out Medicaid forms. She tried calling the state helpline, but she couldn't get through.
EVANS: OK, I'm frustrated right now. I'm just - have other things that were more important and let's not deal with it.
BOLTON: Evans has a job, and her free time is spent finding a place to sleep. There's no public data on how many unhoused people have lost coverage, but experts and homeless service agencies nationwide say it's a big problem. Montana health officials argue they offered training to help outreach workers prepare their homeless clients for the process. Crystal Baker is a case manager in Bozeman, Mont. She says no amount of training could account for errors and paperwork issued by the state.
CRYSTAL BAKER: We're getting mail that's like, oh, this needs to be turned in by this date, and that's already two weeks past. So now we have to start the process all over again, and now they have to wait two to three months without insurance.
BOLTON: And being without health care coverage for any period can be especially dangerous for homeless people, who have high rates of chronic health conditions. Margot Kushel is a primary care doctor and a homelessness researcher at the University of California, San Francisco.
MARGOT KUSHEL: Being out of your asthma medicine for three days can be life-threatening.
BOLTON: Kushel adds that it can be really hard for unhoused people to get back on Medicaid.
KUSHEL: It doesn't seem like such a big deal to fill out paperwork. Put yourself in the position of an elder who's experiencing homelessness and has lost their vision and has no access to computer, no access to car, doesn't have a cell phone.
BOLTON: Back in Kalispell, Tashya Evans was able to sort out her Medicaid application, which is still processing. But others aren't so lucky. Over at the Bozeman homeless shelter, Crystal Baker says she tried to help one of her clients save his coverage, but the state never called back for the required interview to make sure he still qualified.
BAKER: We set a callback five separate times. He waited all day long. It was so stressful for him that he just gave up.
BOLTON: Baker worries his health problems will catch up with him before he catches up on his paperwork. For NPR News, I'm Aaron Bolton in Kalispell, Mont.
SHAPIRO: And this story comes from NPR's partnership with Montana Public Radio and KFF Health News. Transcript provided by NPR, Copyright NPR.
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