Mississippi Governor Haley Barbour told the Boston Globe this week that requiring low-income people to travel to a state office for a face-to-face interview in order to qualify for Medicaid — and return each year for another interview to retain their coverage — holds down costs and keeps ineligible people off the program. The reality, as we explained in a 2009 report, is that Mississippi’s requirement keeps many eligible people off of Medicaid and likely raises administrative costs.
At least 62,000 fewer children and adults in Mississippi were enrolled in Medicaid and the Children’s Health Insurance Program in 2006 (after the requirement took effect in these programs) than in 2004, even as the number of uninsured children in the state rose. Families often have to miss work, find someone to care for children or elderly relatives, and arrange for transportation to far-flung state offices for the interview. So it’s not surprising that nearly 60 percent of individuals up for annual renewal fail to appear, according to a 2007 report.
That report also found that nearly 90 percent of the “new” Medicaid applications Mississippi approves for families and children are for people whose Medicaid coverage had lapsed. This “churning” of eligible people on, off, and back on the program isn’t just a missed opportunity to improve access to health care — it also makes Mississippi’s program less efficient by creating large amounts of unnecessary paperwork.
Most other states have moved in the opposite direction and have streamlined their application and eligibility processes. Only one other state, Tennessee, has retained any face-to-face interview requirement for children, according to the most recent data, and this is only for Medicaid enrollment (not for renewal, and not for CHIP).
Governor Barbour has downplayed the importance of having health coverage, telling the Boston Globe that “There’s nobody in Mississippi who does not have access to health care. One of the great problems in the conversation is the misimpression that if you don’t have insurance, you don’t get health care.’’ In fact, there is substantial evidence that lack of health insurance causes people — particularly people with low incomes — to forgo health care by skipping prescriptions, avoiding physician visits, and so on. That, in turn, can lead to more severe and costly health problems down the road.
The bottom line is that Mississippi’s interview requirement creates an unnecessary and inefficient barrier between low-income families and Medicaid coverage. And barriers to health coverage are barriers to needed care.