Some Medicaid members could be disconnected as the Federal Communications Commission tinkers with how Americans qualify for a 30-year-old program subsidizing phone service, intended in part to ensure access to healthcare.
Last year, more than 12 million households participated in Lifeline, up from about 7 million in 2008, when the program was expanded to include mobile phones, according to the Government Accountability Office. The government spent $1.7 billion in 2015 on the Lifeline, which is funded by a fee on consumers' monthly phone bills. Recipients can use the subsidy, paid directly to the phone carrier, to reduce the cost of a landline or wireless service.
In July, the FCC signaled it might streamline the process for determining eligibility for the program by limiting it to households enrolled in the Supplemental Nutrition Assistance Program, or SNAP, often referred to as food stamps. The government currently also uses Medicaid, Supplemental Security Income (SSI) and Temporary Assistance to Needy Families (TANF) to identify who's eligible.
In response to a formal request for comments, several healthcare organizations sought to discourage the agency from that direction.
“Research shows that while there is significant overlap between SNAP and Medicaid-eligible individuals, the participation rates for SNAP can be extremely low, resulting in eligible individuals who would greatly benefit from the Lifeline program to fall through the cracks,” Molina Healthcare, which focuses its business on Medicaid managed care, said in a comment letter to the FCC.
The agency received more than 200 comments by the Oct. 8 deadline.
Medicaid Health Plans of America said there isn't enough overlap between Medicaid and SNAP to make such a change without cutting off the service for people who need it. “The difference in enrollment between the two federal programs could mean millions of beneficiaries losing access to Lifeline phones,” the trade group says.
People dually eligible for Medicare and Medicaid would suffer the most under a streamlined eligibility process, according to health insurer Cigna. The company concluded from an internal analysis that its dual-eligible members are 50% more likely to have an incorrect or missing phone number in its member database.
Without good contact information, it is difficult to ensure that beneficiaries are able to make appointments for care, follow up with reminders to schedule preventive screenings and tests, discuss chronic care needs with nurses and case managers, or refill needed prescriptions, Cigna says.
Cigna is working with a Lifeline vendor to get regular updates of phone numbers. “It is important that Medicaid remain a qualifying program for Lifeline eligibility because Cigna only has line of sight to a member's Medicaid eligibility,” Cigna said in its letter to the FCC. “Removing Medicaid as an eligibility pathway would make our Lifeline initiative impossible and greatly limit the effectiveness of our care coordination program.”
Some advocacy organizations representing people who rely on Lifeline also raised concerns with the FCC's direction. “Persons with intellectual and developmental disabilities have unique challenges in applying for programs and benefits,” wrote the The Arc, a disability rights organization. “These barriers are greatly reduced for millions of Medicaid recipients if Medicaid continues to be used as a qualifying program.”