As Medicaid waivers begin to expire, Katrina evacuees who need health care are growing ever more desperate.

In September 2005, the Centers for Medicaid and Medicare Services (CMS), the federal agency which administers Medicaid, initiated a Medicaid waiver initiative. Touted by the federal agency as a way to expedite Medicaid enrollment for displaced Katrina survivors without health care insurance, CMS issued a template directed at states that wanted to provide Medicaid services to evacuees. The agency would only approve waivers that limited enrollment and coverage terms of up to five months. Additionally, enrollees had to fall within a prescribed population and income category. Adults without dependent children were not included, regardless of income. The waivers also did not provide for a transition between the emergency Medicaid coverage and the host state’s traditional Medicaid programs.

This short-term coverage began expiring on Jan. 31. All Medicaid waivers will have expired by June 1, leaving thousands of displaced citizens without health care coverage. In Houston, where an estimated 50,000 uninsured storm survivors remain, health care providers are seeing a dramatic increase in requests for services through county resources, such as Harris County Hospital. All host cities are expected to experience a rise in uninsured populations as previous recipients have their benefits terminated.

The state-by-state waiver program is seen by many to have been woefully insufficient to handle the needs of low-income evacuees. Louisiana, Alabama and Mississippi, the home states of the displaced, are among the poorest in the nation. Many survivors were already uninsured citizens living with illness and health problems associated with poverty. However, some evacuees who initially had health care coverage through employers quickly lost it as their jobs disappeared.

Frustratingly, the Bush administration quashed a more comprehensive health plan. A bipartisan bill introduced in September by Senators Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) provided coverage for all low-income displaced persons and allowed for an extension of benefits when needed. It required states to assist beneficiaries in transitioning to traditional Medicaid when emergency coverage ended. A vote on the bill was blocked by Senate leaders after the White House announced its opposition.

Senate Republicans also defeated an amendment to the 2006 appropriations bill introduced by Sen. Blanche Lincoln (D-Ark.). That amendment would have provided full funding by the federal government for evacuees on Medicaid, thereby relieving the host states’ economic burden. As a result of the bill’s defeat, scores of health care providers are reporting slow pay or no pay on services provided and a confused billing process.

While some displaced Katrina survivors are beginning to apply for traditional Medicaid coverage in their host states, one eligibility requirement may immediately disqualify them. Permanent residency in a state is always a condition of qualification. In order to receive Medicaid benefits, evacuees must declare their intention to remain in the host state. This prerequisite to coverage is seen by most to be unfair, as the federal government has failed to address housing needs in storm-ravaged areas. Many evacuees who would like to return home simply cannot do so until affordable shelter becomes available in devastated home states.

The health care needs of Katrina’s displaced survivors are great. While the usual dental, medical and mental health issues are ever pressing worries, storm survivors also are experiencing new health concerns. According to a new study at Colombia University’s Mailman School of Public Health and the Children’s Health Fund, 34 percent of displaced children are suffering from disorders related to anxiety, such as asthma and behavioral problems. This is an alarming percentage when compared to New Orleans’ pre-storm statistic of 25 percent of children presenting with these issues.

More than 43 million Americans are without health insurance; nearly 12 million of those are children. The numbers are often quoted and the statistics seem to ring hollow in policymakers’ ears. However, for the survivors of Katrina, losing even basic medical coverage during a time of so much hardship is simply adding insult to injury.