3/1/2023

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The Spokesman-Review

KXLY


The Center Square

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The Spokesman-Review

Rebooting the state’s Medicaid program could push 38,000 people in Spokane County out of insurance coverage later this year.

With the federal public health emergency decree for COVID-19 set to end in May, states are returning to normal operations for their Medicaid programs.

In Washington, the program is known as Apple Health.

Those normal operations include stopping continuous Medicaid enrollment. During the pandemic, about 300,000 people in Washington – including 38,000 in Spokane – were kept on the government insurance program designed to provide medical coverage for poor people, regardless of whether they took higher-paying jobs or failed to respond to eligibility inquiries.

People on that continuous enrollment after April 1 will have to renew their eligibility for Medicaid for the first time in three years.

Most will get renewal notices in May, June and July, said Amy Dobbins, a Washington State Health Care Authority Medicaid eligibility section manager.

“In March of 2020, it was the Families First Coronavirus Response Act that really implemented that continuous enrollment requirement for anybody who was active on Medicaid or became active on or after that effective date,” Dobbins said.

“So states had to keep folks open regardless of changes to income. In that Families First act, the states could get enhanced funding if they continued coverage for people through the end of the Public Health Emergency.”

While some people among the 300,000 may no longer qualify after April 1, others who had continuous enrollment might retain Apple Health if they still meet Medicaid eligibility and answer the upcoming notices, Dobbins said.

During the past three years, the overall number of people with Medicaid coverage statewide also grew. Prior to March 2020, about 1.8 million people were on Apple Health in Washington, and it’s now just under 2.3 million people statewide, Dobbins said.

Under the COVID provisions, the health care authority could stop continuous coverage after a death, or if someone moved out of state, requested removal or didn’t provide information to verify identity. But in most cases, even if people didn’t respond to notices since early 2020, the agency had to continue coverage because of the federal requirements, she said.

“If they came through and it looked like they were no longer eligible, or if they never came through, we just extended their coverage by three months at a time throughout the last three years,” Dobbins said.

“The 300,000 is mainly people who haven’t responded to letters to renew their coverage. It’s also people who came through and said they had income over the standard, and we had to do some manual work to make sure that their coverage stayed open. That federal regulation required us to keep them covered.”

What’s different is in another month, people under continuous enrollment will receive one last three month extension, she added, “which is why those first three months will be the highest volume for just the 300,000 ... but we’re still also running renewals for everybody else.”

The state sends notices in advance of a person’s renewal date during the 12 months. People with continuous enrollment who are found ineligible could lose their coverage as early as April 30, but more likely at the end of May.

It’s difficult to estimate how many among the 300,000 might lose coverage, until responses are or aren’t received, Dobbins said.

If their Apple Health coverage ends, people can search for a plan on the state health insurance exchange, wahealthplanfinder.org.

The agency is seeking volunteer ambassadors to help people update their insurance or respond to renewals. Ambassadors might be at health care clinics, schools, government offices or community centers.

Caitlin Duffy, director of business development and sales at Community Health Plan of Washington, said the nonprofit has geared up to help before people lose Apple Health coverage. The nonprofit is among outlets providing Apple Health, Medicare Advantage and individual and family health plans.

A similar agency in Spokane is Better Health Together.

Duffy said Apple Health enrollment rose significantly during the pandemic.

“Part of the reason for this is no one was kicked off of Apple Health, and typically you’d see some natural churn where people come off and on Apple Health depending on their eligibility in the last three plus years,” Duffy said.

“We really haven’t seen any of that because the state has to allow for that continuous enrollment, while more and more people have become eligible for Apple Health.”

She said that Spokane County had nearly 200,000 total Apple Health clients as of Jan. 25. Among them are the nearly 38,000 on a continuous enrollment status.

“These are the people most at risk of losing their Apple Health coverage because they have either not sent in any sort of documentation showing they’re still eligible over the course of the last three years, or they did send in some documentation or completed a renewal and the state internally flagged them as potentially no longer eligible.”

There are proactive steps to take, Duffy said, such as updating Apple Health contact information; checking mail and email frequently for notices from the state; and completing a renewal form to avoid loss of coverage.

If Apple Health coverage ends, there are affordable options on the state’s health plan exchange, she said.

“Many of these plans have subsidies and other cost-share savings that drop the premium to sometimes lower than $10 per month.”

Treva Lind can be reached at (509) 459-5439 or at treval@spokesman.com.

Ordinances create rental registry, method to enforce standards

After months of debate, the Spokane City Council has passed a bevy of controversial rental reforms to provide greater protections for tenants and increase enforcement of substandard housing.

In large part, the reform’s advocates sought to make it easier to look for a new rental, to ensure rentals are habitable and meet various requirements, and to support tenants if a landlord violates their rights.

The ordinance, brought forward in November and delayed multiple times for more debate and compromise, underwent a number of changes before Monday’s vote. At the last minute, the reform package was split into two, with one ordinance that had unanimous support and another opposed by the Council’s conservative members.

Ordinance 36330, focused on a registry of rental units in Spokane and increased enforcement of substandard rental units, received unanimous support from the seven Council members.

“That 7-0 vote, I thought, was pretty powerful,” Council President Breean Beggs said in a brief interview.

The compromise ordinance also clarifies an existing but rarely enforced requirement that landlords have business licenses.

In addition to paying licensing fees, landlords will have to pay a fee of $15 per rental unit, with some exceptions.

Those additional revenues will be used to help fund at least three extra code enforcement positions specifically to inspect rental housing. Fees collected by the additional code enforcers would also help to pay for the program.

“It is a sad statement for us as a city that we had not been enforcing the laws already on our books,” Councilwoman Betsy Wilkerson said shortly before the vote. “We are trying to get this dedicated funding to up our game, to make the units that are out there safer and more habitable.”

In addition, the Spokane Office of Civil Rights is now authorized to hire a housing ombudsman who can help both landlords and tenants.

Ordinance 36366, which contained broader reforms to make it easier to find a rental, was opposed by Council members Michael Cathcart and Jonathan Bingle, who cited in part concerns about overregulation and downstream effects on rental stock and renters.

“One of the big things I wanted to avoid as much as possible was any direct fees to tenants,” Cathcart said in an interview.

“Affordability is the first and loudest thing I heard from tenants.”

That latter ordinance creates new anti-retaliation protections for tenant-rights advocates and requires landlords to disclose a history of mold or meth manufacturing in the unit.

It also sets aside funds to support tenants who need to relocate because of uninhabitable living conditions, and to mitigate damages to landlords caused by a resident receiving rental support from a government or nonprofit.

“Landlords wanted a mitigation fund when they rent to riskier tenants who cause damage, and tenants want a fund for relocation when they have a really bad landlord and it takes months and months to go to court for the state-authorized relocation fees,” Beggs said.

Cathcart strongly supported the creation of a mitigation fund to support landlords, and had called for a broader version than what was passed Monday.

He expressed doubt that it would function as it was drafted.

“I have heard that we likely need millions of dollars in a mitigation fund, not $60,000,” Cathcart said. “So I fear that creates a false promise, that we’re going to have this mitigation fund, that is probably just going to address three to seven units.”

Ordinance 36366 also creates a “portable” background and credit check that landlords can voluntarily accept.

Originally proposed as a “universal” background and credit checks, where a tenant could pay for the service once and all Spokane landlords would be required to accept it, landlords would not be required to accept the portable check. While this change may seem to defang the provision, many local landlords and property managers use the same company for background checks, which Beggs argued makes an effective voluntary system seem more plausible.

In a Monday night news release, Mayor Nadine Woodward reiterated her support for the ordinance supported by Cathcart and Bingle, and her opposition for the broader reforms passed by the left-leaning Council supermajority. She argued that the new portable background check and other regulations could hurt the city’s already insufficient affordable housing supply.

“While I appreciate that some give and take occurred, the risk is still very real that the new regulations imposed on landlords will harm the very tenants it is intended to help,” she wrote.

Emry Dinman can be reached at (509) 459-5472 or by email at emryd@ spokesman.com.

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