Severe Hep-C is a condition that will usually qualify an individual for Social Security Insurance. Individuals on Social Security for disability purposes qualify for Legacy Medicaid. In most states individuals who qualify for Legacy Medicaid based on disability status will have streamlined or auto enrollment in a variety of safety net programs (heating assistance, housing assistance, SNAP, some job training programs etc). The logic behind this auto-enrollment is to streamline cases where there is a very high probability that if a person is on SSI, they will qualify for everything else and that as a class, most of the people are “deserving poor” so politically it is easy.
This program logic was built out with an assumption that most people won’t get better, that they’ll just (at best) stay stable or decline slower.
Now with the creation of highly effective but expensive Hep-C cures, this logic does not work anymore.
People who were originally Medicaid qualified as part of SSI received a Hep-C cure. These individuals then follow three pathways. The first is that they are non-compliant and not cured so they still have Hep-C. The second is that they were medically compliant but their bodies did not take the cure so they still have Hep-C. Finally, they got cured. The first two groups are fairly simple from a policy point of view. The first group is still on Medicaid for SSI. They may or may not get another round of treatment depending on state policies. The second group is also simple. They are still on Medicaid through SSDI qualification. Once their doctors can figure out why the cure did not work, there is a very good chance that they’ll get another round of something slightly different to see if that works.
It is the third group which is an interesting policy challenge. They are cured. A good proportion of this universe now no longer has a medical disability according to Social Security. Some of these people will have comorbidities that will re-qualify them for Medicaid through SSI. A decent number of people won’t requalify for SSI or Medicaid through SSI. Their support structure that they previously auto-qualified for is now based on individual application qualification. Some of these people will re-qualify for Medicaid Expansion or other Legacy qualification categories. States would prefer that these individuals qualify for Medicaid as Expansion category individuals as the Feds take up 100% of current costs and over the long run take 90% of the costs. Any other qualification has the state picking up between 30% to 50% of the costs.
So the question is how do people who were previously assumed to be very long term SSI recipients who are now cured and losing their qualification for Medicaid and other wrap around services transitioned? Is there a slow off-ramp with plenty of assistance on navigating the system or is it a brick wall?