The pandemic has caused an increase in people enrolling in Medicaid. That’s true across the country and in Alaska, too. In the last six months, more than 12,000 people have joined the program in the state.
In Alaska, Medicaid is known as DenaliCare and Denali KidCare.
And it’s covering more Alaskans than ever — 232,735 as of Aug. 31, or nearly one in three state residents, including most children.
The biggest concentration of new enrollees has been among young adults.
Darren McKnight is one of them. A 30-year-old Ketchikan resident, McKnight enrolled in the program in May. If this were a normal summer, he probably would have found work as an experienced cook, and that could have paid his health care costs. But this wasn’t a normal summer.
“Tourism taking the hit that it has in Ketchikan was definitely the last nail in the coffin,” McKnight said.
Receiving Medicaid has provided assurance for McKnight — it paid for two COVID tests, which came back negative. And it’s allowed him to receive mental health treatment that he described as life-saving.
“Plenty of folks are losing jobs,” he said. “Plenty of folks are losing insurance. I’m sure a lot of people are getting a lot of the help that they really need.”
Alaska’s Medicaid enrollment increase has been more than 5%. That’s actually a smaller increase than most states have reported.
Some of the groups that are signing up fastest in Alaska are women and people who live in northern, western and southwest Alaska.
Job loss is a big reason for the increase, but it’s not the only one.
Medicaid enrollment usually has a churn to it — people are constantly joining and leaving. But that’s not happening now. No one’s leaving because the federal government has prevented the state from dropping people during the pandemic.
Right now, that’s benefiting the state’s bottom line. The federal government is paying for a larger share of the costs for most Medicaid enrollees — 56.2% instead of the normal 50%/50% split between the federal and state governments. But in return, the state can only end Medicaid for people who’ve died, moved out of state or asked to be removed.
Shawnda O’Brien oversees Medicaid enrollment as the director of the state Division of Public Assistance.
“The intent is really to keep more people eligible during the pandemic and not have folks without health care,” she said of the federal rule.
This isn’t the first time Alaska has seen Medicaid enrollment jump. Just five years ago, Medicaid was expanded under the Affordable Care Act and former Gov. Bill Walker’s decision to expand the program under that law. Enrollment went up, from 125,616 in September 2015 to 219,260 at the end of last year, with most of the increase due to the expansion.
But that increase was accompanied by a significant backlog of people waiting to get into the program, which at one point reached 27,000.
It hasn’t happened this time.
O’Brien said a quick response to the pandemic, including from state staff working from home, has contributed to that.
“From the time an application comes into the office and the time that a staff person takes a look at that application is usually within three days,” she said.
It can take more time when the state needs more information. But O’Brien says that the state is staying within the 45-day window to process applications that’s required by the federal government.
But more patients can mean more need for health care services. The impact on providers has varied across Alaska.
Some providers are seeing more patients, with different types of services required as a result of COVID-19.
Carol Austerman is the executive director and CEO of the Kodiak Community Health Center.
“We are definitely seeing an increase in the number of patients that we’re seeing right now,” she said. “They’re COVID-related. And we’re doing a large increase in testing.”
In addition, there’s been a big shift in how the center is serving patients. Before the pandemic, only one out-of-state psychiatric nurse practitioner was providing remote telehealth care. Now, all of the Kodiak center’s providers provide telehealth care.
While more Alaskans are covered by Medicaid, it’s not yet clear if the state will have to spend more money on the program, which is the second largest in the state’s budget after public education.
Policymakers are struggling to close the state’s budget deficit, which is more than $1 billion, and would be more than $2.3 billion if the state paid Permanent Fund dividends using the formula in a 1982 state law. The state’s share of total Medicaid spending is $645 million.
But the state Department of Health and Social Services said Medicaid spending in the first 11 weeks of the state budget that started in July is on track with what the state projected.
Even if the enrollment increase doesn’t directly cause a spending problem, the state faces another Medicaid budget challenge on the horizon: The increased federal match could end in December. But that’s only if the federal government doesn’t extend the national public health emergency, which is scheduled to expire on Oct. 23.
Andrew Kitchenman is the state government and politics reporter for Alaska Public Media and KTOO in Juneau. Reach him at akitchenman@alaskapublic.org.
