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Medicaid beneficiaries appear to be vulnerable following Hurricane Florence.

The wildfires in California, as well as Hurricanes Harvey, Maria, and now Florence demonstrate and present new challenges. The intensity of the wildfires and the incredible rainfall brought far worse risks to life, property, and recovery than prior natural disasters would historically indicate. People were caught off-guard.

Experts have suggested that this level of destruction is the “new normal,” brought on by prolonged drought and warmer oceans.

What are the implications if this is new normal? New questions arise: how long will it take to rebuild? What about my job, my business? What about my health coverage? Will the safety net, which includes Medicaid, be there for me if I lose these things? The story of society’s most vulnerable gets little attention, but in this case, it must. I fear that this story ultimately will involve many, many more people.

After Harvey, the Texas Gulf Coast instantaneously lost 27,000 jobs. According to the Federal Emergency Management Agency (FEMA), more than 40 percent of smaller businesses never reopen after a disaster, almost entirely because of lack of financing. Health insurance coverage is an early casualty. Providers with reduced revenues, even if temporarily, feel exacerbated pressures from unreimbursed care, especially in non-Medicaid expansion states. Not my words, but from providers.

After Harvey, payers announced temporary relief to help mitigate some revenue flow disruptions. Blue Cross announced plans to do the same in the aftermath of Florence. But this doesn’t pay the insurance premiums or address the resulting lapses in coverage. Will there be a safety net, i.e. Medicaid?

The immediate solution for many: getting healthcare in the ED.

Some call this a public health crisis. But I predict very soon, this will become a population health management challenge. Instead of congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), we will be increasingly addressing the effects of loss of the basics for a prolonged period. Will this type of population health management become commonplace?

What will it look like if it does? How will the response be made sustainable?

Financing is becoming available for population health, including homelessness, in some states for the Medicaid population, but these programs are still in their infancies. The future becomes unclear if federal dollars decrease.

To affect a safe discharge, many providers feel pressure to assist with a supply of medications, plus finding solutions of where to call home and how to provide meals, and seasonally appropriate clothing. It becomes an all-encompassing task for social workers in EDs, and in acute settings, it’s mostly unfunded. What if those patients do not qualify for Medicaid in their states? EDs have already seen a leap in non-emergency presentations, such as the elderly or chronically ill, with no place to go, no one to care for them, and no payor.

This discussion needs to take place. Florence continues to be horrendous. Can communities absorb the massive losses? Look at the lingering effects of Katrina and Maria. If history means anything, healthcare providers will be called up to be part of the plan. What are our disaster plans to manage these lingering, possibly permanent issues for those to who look to us for help in sustainable ways?  

That’s something for future discussions.


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