The Medicaid unwinding is having unintended consequences on other safety-net services, making it difficult for low-income families that rely on other public assistance programs.

MISSOULA, Mont. Shelly Brost, an hour before dawn broke, walked in freezing rain a mile to the office of public assistance. She had run out of time after being blocked by a state call center.

She had tried twice to call Montana’s helpline for public assistance to complete the interview necessary to recertify Supplemental Nutrition Assistance program, or SNAP benefits. The call was dropped each time after an hour of waiting.

Brost, who was waiting in line for the opening of her office with about a dozen others on a November morning, said: “I was almost ready to cry.” “I have a 13-year old kid who is hungry.”

In the rush to find out if tens or millions of people are still eligible for Medicaid, after the pandemic-era disenrollment freeze ended this spring, low-income families who need safety-net programs, like food and cash assistance have been collateral damage. People whose renewal and application forms were lost or delayed, or, like Brost couldn’t reach overworked government call center staff, are affected.

The impact of the Medicaid “unwinding” on low-income families has been overlooked. Since April, millions of people have lost their coverage. Millions more are expected to do so in the months to come.

Leighton K. Ku, Director of the Center for Health Policy Research at George Washington University Milken Institute School of Public Health’s Center for Health Policy Research, said that “the Medicaid dewinding has caused huge problems for administrative personnel.”

According to the Center on Budget and Policy Priorities in Washington D.C., a think tank with a leftist lean, most states use the same computer systems and workers to determine eligibility for Medicaid and SNAP. Signing up for public assistance benefits can be difficult depending on the way each state has set up their programs and how well staffed agencies are to handle additional work due to Medicaid redeterminations.

Public aid seekers have long had to wait at call centers and there were few options for help in person. These long-standing issues have gotten worse as a record number of Medicaid recipients ask for help enrolling.

Lawyers and groups assisting applicants in Montana, Missouri and Virginia said that applications had vanished without any response, and calls to workers who determine eligibility were often unanswered.

Megan Dishong is the deputy director of Montana Legal Services Association.

SNAP is about half the size of Medicaid. In April, almost 42 millions Americans received assistance with food, compared to 87.3 million Americans who were enrolled in the health coverage program.

SNAP has seen major changes in the past year. A policy that increased benefits for those affected by the pandemic was discontinued, and work requirements were reinstated. According to federal data from the latest quarter, enrollment in SNAP dropped 1 million between January and August. This is much less than Medicaid enrollment, which began to decline in April.

Official data sources do not capture the delays and other problems people have in receiving benefits.

Majesta-Dore legnini, a Legal Aid Justice Center Equal Justice Works Fellow who works on SNAP, said that in Virginia, where local state Department of Social Services offices handle Medicaid and SNAP application, “I have had several clients submit applications, and they just went into the ether.”

After three months, a client who applied for assistance the first time did not hear back and was forced to reapply. After a lengthy application process, denial letters, and appeals, another client received benefits in 2 1/2 months. After being incorrectly cut off, a family with mixed immigration status – the children were eligible for benefits – did not receive benefits for 8 months.

Virginia must process all applications within 30 days. Legnini says that most of her clients are parents of children under 15. They often tell her, “They’re struggling to get enough food for their kids.”

A federal lawsuit filed in Missouri before the unraveling began claims that a dysfunctional food assistance system is preventing low-income residents to receive it. According to a document filed with the case, more than half of Missouri applicants in July were denied food aid because they could not complete an interview. This was because they weren’t eligible.

Mary Holmes, a St. Louis woman aged 57 with chronic illnesses and throat cancer, had her application denied in February 2022, because she could not reach a call centre to complete the interview. Holmes called the call center repeatedly, but she waited on hold for hours with other people. After a judge in March 2022 reprimanded the state over the long waiting times, her benefits were restored. The lawsuit is still open.

Advocates said that now, as Missouri has reassessed the Medicaid enrollment for more than one million recipients, those systemic problems have escalated to a crisis, especially for the most vulnerable.

Joel Ferber is the director of advocacy at Legal Services of Eastern Missouri. He represents Holmes and other plaintiffs.

According to a case filed recently, state officials claimed they “made significant progress” in making interviews more accessible. For example, by hiring “outside vendors for Medicaid calls so that more state employees can handle SNAP interview.”

Montana officials stated that the Medicaid redetermination processes collided similarly with an already troubled state system.

Charlie Brereton , the director of the Montana Department of Public Health and Human Services , told legislators that the state is working to improve the public assistance helpline, which has “been plagued by some challenges and issues over many years.”

Brereton stated that the agency raised the salaries of client coordinators in order to fill jobs on-site. The state hired about 50 workers to complement the call center staff. It also created a separate line on its helpline for people who were applying for temporary cash or food assistance.

Jon Ebelt of the Montana Health Department did not directly answer how long callers waiting for SNAP or cash assistance are on hold, but said that applications were “processed in a timely manner.”

The long waits for people trying to access the state system continued in November.

Since April, Montanans have received SNAP benefits in a nearly 5,000 less number. Lorianne Burhop is the chief policy officer of the Montana Food Bank Network. She said that this doesn’t mean fewer people are eligible. If you don’t have internet access, unlimited phone minutes or can’t travel to the public assistance office, it may be difficult for clients to maintain their benefits.

Burhop stated, “We have seen consistently high numbers in food banks whereas SNAP has been trickling down.” “I believe you need to take into account access as the factor driving this decline,” Burhop said.

DeAnna marchand in Missoula waited for a Montana helpline to answer as the deadline of November approached. She was one of many people who faced multiple deadlines. One to recertify her food assistance and that of her grandson. Another to prove her eligibility for Medicaid, which pays for an in-home caregiver. And a third for keeping her grandson’s Medicaid.

Marchand replied, “I have no idea what they want.” How am I going to get it if I don’t have a way to talk with someone?

She followed the prompts after a half-hour to schedule a follow-up call. A voice on the automated system informed her that all slots were taken and she was instructed to wait again. The call was dropped an hour later.

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