Episode #17: Medicaid Redetermination: Stories from Families to Inspire Action

According to the Kaiser Family Foundation’s Medicaid Enrollment and Unwinding Tracker, as of February 1, over 16.4 million Medicaid and CHIP enrollees nationwide have been disenrolled and lost their coverage. Over 70% of people are losing coverage because of paperwork reasons, such as missing notices from the state Medicaid office and an inability to produce wage statements. Out of the states reporting age breakouts, children accounted for 38% of Medicaid disenrollments. 

Our latest MCH Bridges episode highlights the human experiences of what these alarming statistics mean for families across the country and emphasizes the role of leaders in maternal and child health (MCH) during this ongoing issue. Guest host Atyya Chaudhry dives into the stories of those with lived experience of losing Medicaid coverage and what organizations like the Florida Health Justice Project are doing to make an impact. 

Tune in to these important conversations with our guests Janis Fay and Alison Yager, who share their experiences and insight, as well as action steps that MCH advocates and individuals who are experiencing coverage loss can take.

Resources: 

• AMCHP Resource Library: Promoting MCH Coverage 
• Children with Medical Handicaps (referenced in the episode) 
• Lily’s Story & Christina’s Story (referenced in the episode) 
• AMCHP Blog Post: The Medicaid Unwinding Process at the Halfway Mark: How Can MCH Advocates Address the Current Challenges to Ensure Continuity of Coverage for Children and Families?
• AMCHP Blog Post: MCH Advocates are Alarmed About the Rapid Loss of Child and Family Coverage in the Medicaid Redetermination Process 
• Florida Health Justice Project - Medicaid | The Lived Experience: Unwinding the Continuous Coverage Requirement

Transcript

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Atyya Chaudhry: [00:00:00] Welcome to MCH Bridges, where we lift up innovative ideas and inspiring stories from people in the [00:00:15] maternal and child health field. My name is Atyya Chaudhry, and I am a Policy Consultant at AMCHP and your guest host for this episode. Medicaid unwinding is causing people with disabilities to lose coverage with devastating consequences. 

More children are losing [00:00:30] Medicaid coverage as child poverty grows. Worse than people can imagine, Medicaid unwinding breeds chaos in states. Those are just some of the headlines we see as we are in the midst of an unprecedented process to redetermine all Medicaid and CHIP [00:00:45] enrollers for eligibility. But how did we get here? 

At the beginning of the pandemic in 2020, policies were put in place to respond to the public health emergency, including allowing all children and adults enrolled in Medicaid and CHIP to retain their [00:01:00] coverage. That means for at least three years, no one had to go through a Medicaid renewal. Now these policies have ended and all 95 million individuals on Medicaid or CHIP must go through a renewal to determine if they are still eligible for Medicaid coverage. 

We [00:01:15] are at least nine months into the process. And there are still significant challenges stemming from confusing consumer information, to long call center wait times, to understaffed Medicaid agencies, and overall lack of awareness among families. These challenges are resulting in [00:01:30] extremely high rates of disenrollment. 

Well over 15 million Medicaid and CHIP enrollees nationwide have lost their coverage since the end of January and children accounted for about 4 in 10 Medicaid disenrollments in states that were reporting age breakouts. The [00:01:45] vast majority of people are losing coverage, not because they are determined to be legitimately ineligible, but for paperwork reasons, such as missing notices from the state Medicaid office and an inability to produce wage statements. 

Unfortunately, the number of people losing coverage [00:02:00] will continue to rise. However, these disenrollment numbers are not going unnoticed. The current administration has taken note and put forth policy flexibilities that states can apply for and robust consumer communications in multiple languages. The rate of coverage loss is [00:02:15] outpacing predictions by policy experts and poses a significant concern for those in the maternal and child health field. 

Children and families continue to lose their coverage every single day, often with little understanding of the appeal process or other sources of coverage. This is [00:02:30] an emergent issue in MCH, and we have to pay attention. In this episode, we are joined by two guests who will share their insights and experience during the Medicaid renewal process. 

We will hear from Janis Fay, a mother of three from Cincinnati, Ohio, who will share her first [00:02:45] hand experience navigating this process. And then we'll hear from Alison Yager, an attorney and executive director at the Florida Health Justice Project. 

Janis begins by telling us a little bit about her [00:03:00] family.  

Janis Fay: So, um, my family consists of, there's five of us. There's me, my husband, and our three children. We also have two dogs. We're pretty wild. My husband's a musician, so he's training all of our kids to also be musicians, [00:03:15] so it's very loud in here all the time. 

Atyya Chaudhry: Janis's family is one of millions impacted by the Medicaid renewals. Her story really highlights how challenging it is to navigate the renewals process.  

Janis Fay: Well, um, it has, it's been terrible, [00:03:30] honestly. Back in July of 2023, we received a notice from our local JFS office stating that our children would be provided continuous eligibility. 

Atyya Chaudhry: JFS is the Ohio Department [00:03:45] of Job and Family Services. 

Janis Fay: And with that, I was relieved because I knew that this Unwinding was happening and I was very nervous. Our whole family was nervous given that two of our kids have special healthcare [00:04:00] needs, actually three now, we just found out our third one has a special healthcare need too. 

The JFS notice that we got, I was relieved as I said, but then in [00:04:15] September, like the first week of September, my son's orthodontist called us and said, “Hey, you don't have health insurance anymore for your son and you guys are going to have to pay out of pocket.” So that kind of upset me. I was confused. I called [00:04:30] his insurance company to verify that. 

And they were like, yeah, no, he doesn't qualify for insurance anymore. So then I got on the phone with our local JFS office and I asked them what's going on because they had sent a notice saying that we were covered [00:04:45] or that our children were covered. And the lady I spoke to, she told me that they were aware that their office was sending out incorrect notices to families. 

And, you know, I asked why they [00:05:00] didn't send out a follow up notice saying, oh, we made this mistake, actually, your child is not going to be covered. And we were kind of stuck in this emergent situation where we had to get coverage right then. So that was a little [00:05:15] scary. It was scary because we can't really afford health insurance for our children, the kind that we would need to cover all of their health care needs. 

And we also can't afford to pay out of pocket either. So we were kind of stuck.  

Atyya Chaudhry: Janis tells us a little more about her family and [00:05:30] her children's complex medical needs and how hard she had to fight to get an Individualized Education Program, or IEP, for her daughter. All of this because they lost their Medicaid coverage. 

Janis Fay: I have a 13-year-old and a 7-year-old. My 7-year-old is [00:05:45] autistic and she also has a chronic health condition along with that. She has a lot of anxiety about going to school due to her autism, and the school would not, you know, accommodate that very [00:06:00] well. So because of that, I ended up homeschooling her and Ohio has a really great program for autistic children called the autism scholarship.  

So that pays for special schools for children with [00:06:15] autism, and it pays for other services as well, like in home therapy or occupational physical therapy, you know, and other different types of therapies, like hippotherapy, which is horseback riding therapy, which is great. [00:06:30]  

But, I had to withdraw her from the school, fight the school for her to get an IEP after that, because they wouldn't give her an IEP while she was enrolled. So after I withdrew her, that's when I fought for the IEP. And I finally got [00:06:45] one for her, just so we could utilize the autism scholarship, just so we could get her some of the services that she needs. 

All of this because she has no Medicaid. And my 13-year-old, [00:07:00] he has scoliosis and it's pretty significant. We actually just found that out a couple months ago. So that means he's going to need to wear a brace and that brace is going to cost upwards of, you know, $10,000, [00:07:15] which we don't have. And our insurance that we ended up getting through my husband's employment that will not cover any of that. 

It actually doesn't cover any health care until we pay our deductible, which is very [00:07:30] high. I think it's like $8,000 for our family. We have to pay that before they'll kick in. So, yeah. We just can't really afford health care right now, but we make too much for Medicaid.  

Atyya Chaudhry: During the pandemic, Medicaid and CHIP covered almost half of all U. S.[00:07:45] children with special health care needs. Now with the renewals happening, children are losing coverage at alarming rates. Nearly 3 million children have lost coverage in the states reporting age breakouts. This is very concerning for maternal and child health advocates. I go on to ask [00:08:00] Janis her thoughts on what more maternal and child health professionals can do to support families during this process. 

Janis Fay: I mean, they did pretty much a fantastic job with letting us know it was going to happen and that we needed to go on the website and update our [00:08:15] information and all of that. But there really was nothing after that from them other than, you know, you get a notice that says, yes, you're still covered or no, you're not covered. 

That was where they left people. [00:08:30] And in my opinion, I feel like they should have also sent out when you get the notices saying that, no, you're not covered anymore, but here are some resources for you. I feel like that should have been given to families who were not found [00:08:45] eligible anymore because now, months later, I mean, this is four or five months later, I am still working full time at home by myself, trying to figure out how to get things paid for my [00:09:00] children. You know, obviously, we are paying some things, but we're having to use our credit cards to pay for things. 

And, you know, we're just going deeper and deeper into medical debt, and that is not okay. It's not okay for us, it's not okay for anybody who has [00:09:15] been kicked off of Medicaid. I was lucky to find out that there is, and this took me a couple months to even find, but there is a program called Children with Medical Handicaps that our [00:09:30] state has so that has to be approved, though, and your doctor has to enroll you in it. 

And then you have to go through all of the application process with the state with that program through the state and [00:09:45] that takes a while. So you don't really know if you're going to be approved or not for that. And then when you finally do get approved, it's just for a diagnostic portion and not for the treatment. 

So you get the diagnostic portion, [00:10:00] but then you have to reapply for the treatment part. And again, that will take another month or two. So it's a good program, I guess, if you have it in place prior to losing Medicaid, but obviously [00:10:15] that is not what happened to us. So here we are stuck with waiting, a waiting game, like, for instance, my son with scoliosis who needs the brace for his back that you know is super expensive.  

We can't get that brace [00:10:30] until we know that it's going to be covered by this program, the children with medical handicaps program. He's at an age where he's almost done growing. And we were told that if he does not get this brace soon to help correct his [00:10:45] spine that. 

He will eventually need spine surgery, which that will cost even more than the brace, you know, and plus, who wants to put their child through spinal surgery? I mean, it's pretty [00:11:00] awful.  

Atyya Chaudhry: Janis's experience highlights how hard families have to advocate to provide basic medical coverage for their families, the multiple systems they have to navigate on their own, and how complicated this whole process can be. 

Janis shares some words of advice for families going [00:11:15] through this process. 

Janis Fay: Just keep asking questions and keep fighting kind of like what I've been doing. Um, unfortunately, I know a lot of people don't have time to spend their entire day searching [00:11:30] and calling people and trying to talk to other families and figure out what everybody else is doing to get through this. 

I mean, it's difficult for me as a stay-at-home, homeschooling mother who has the time. to do that. I [00:11:45] can't imagine what it's like for people who actually work. But you know, my advice is to keep asking questions to whoever you can. Call your doctor. Ask them if they know of any resources. Ask your local children's [00:12:00] hospital. 

They usually have a department that knows of these resources. You don't know until you ask.  

Atyya Chaudhry: As we wrap up, Janis shares some final thoughts about this whole experience. 

Janis Fay: I just wish that Medicaid would have [00:12:15] a longer grace period after the notice saying that you're going to be cut off on this date, you don't qualify after this date, but we're going to extend it for six months so that you [00:12:30] have time to figure out what you're going to do before it's completely dropped. 

I think that would be ideal because we only had, like I said, the notice that we got in July, which was false. And by [00:12:45] the end of August, we were completely cut off unbeknownst to us. But if that notice had been correct, we would have only had like a little over a month to figure out what we were going to do as far as getting health insurance for our [00:13:00] children. 

I don't feel like that's enough time for us, and it's definitely not enough time for a majority of Americans. 

Atyya Chaudhry: In this next portion, I chat with Alison Yager, [00:13:15] attorney and executive director at the Florida Health Justice Project, whose organization has been at the forefront amidst the chaotic Medicaid redetermination process.  

Alison Yager: Florida Health Justice Project has been involved in advocacy and public [00:13:30] education around the Medicaid redetermination process well in advance of the start this past April. 

We saw this coming down the pipe. We knew that this would be a [00:13:45] massive disruption to enormous numbers of individuals and families across the state and across the country. And so well before we even knew when the unwind was going to begin, we [00:14:00] started working on public education, putting out information with regard to specific subpopulations about how they would be impacted by the unwind, opportunities for finding [00:14:15] alternate coverage, what people needed to do in order to ensure that they would receive the notices that the state would be sending out to keep their accounts up to date, to be sure that they were on the lookout for mail when it would [00:14:30] start arriving. 

And we also worked really closely with numerous other organizations, allied organizations around the state, because this is not a one organization undertaking. This is collective work that really needs [00:14:45] people in every corner of the state, in every community, educating folks, advocating, calling out the injustices and the errors when we're seeing them. 

And amplifying the voices of people who are [00:15:00] living these experiences. Once the unwind started and we saw just, in fact, just how widespread the devastation was, we knew that, that one of our chief roles was going to be to lift up the [00:15:15] voices of people who were experiencing erroneous or unexpected terminations from coverage. 

Atyya Chaudhry: Across state's reporting data, over 71 percent of people disenrolled have their coverage terminated for procedural [00:15:30] reasons, meaning they did not complete the renewal paperwork or the state has outdated contact information. High procedural termination rates are concerning because many disenrolled may still be eligible for Medicaid coverage. 

Alison Yager: Another important thing to [00:15:45] mention is that we have filed a lawsuit against the state in connection with our partners at the National Health Law Program have brought a legal challenge, the focus of which is very narrow. Essentially, [00:16:00] we are challenging the reasons that have been given by the state when Medicaid is terminated for individuals, so when Medicaid closes a case, they send a notice saying why the case was [00:16:15] closed, and the allegations in our suit are saying that the state's notices don't give individuals enough information to be able to evaluate whether the termination of their Medicaid is correct or [00:16:30] not. 

And these notices at the basis of this case are incredibly confusing. They are often long and contradictory. So on one page, they'll say you are eligible. On the next page, they'll say you're ineligible. [00:16:45] Sometimes they say you have other coverage, even though people don't. And so this legal challenge is to say that the notices don't give people enough information to determine whether the termination of Medicaid was correct. 

And [00:17:00] just a little update on that lawsuit, the judge held a hearing on December 13th. That hearing was on whether to certify the case as a class action and to hear our request for preliminary injunction, [00:17:15] essentially asking for the court to sort of take immediate action to halt the state's processes. The judge has not ruled yet, so we in the state, the parties are currently providing [00:17:30] additional legal briefing as requested by the court, and the court has ordered an expedited case schedule, so we have trials set for mid- May. 

The challenge, of course, is the [00:17:45] unwind continues in the background, and so time is of the essence. But we are the first and I believe still have been the only case to bring a court challenge to [00:18:00] the unwind process. And I will also say another piece of our work has been helping individuals. So we did in anticipation, all sorts of community education and educating of other [00:18:15] social service providers and health care providers. Once the unwind started, we, as widely as we could, shared our contact information so that people who [00:18:30] were confused about what was happening with their case, who received a termination notice that they felt was wrong, could get in touch with us and that we could assist folks. 

We've assisted at this point well over a hundred people who've, [00:18:45] you know, reached out to us with questions or with the belief that their termination was inappropriate. And so we're doing all we can to, to help all the folks who are connecting with us.  

Atyya Chaudhry: Stories from people going [00:19:00] through Medicaid renewals have been especially important during this process. 

We'll hear from Alison about uplifting voices from the community and sharing stories from those who have lived experience.  

Alison Yager: Story work has been important to [00:19:15] FHJP's approach to advocacy from our inception nearly six years ago. We really believe that you can't talk about issues around healthcare policy and so many [00:19:30] other social determinants of health without hearing from the individuals who are impacted by these issues. 

The policies we advocate around are really weedy, and sort [00:19:45] of a legal tangle, often very confusing, hard to parse, and it takes hearing. the impact of those policies on individuals in order to really understand [00:20:00] the importance of the issue at hand. And so we've always known that to be effective advocates, we needed to partner with individuals who were willing to share their stories. 

And that [00:20:15] takes so much courage and it's a huge gift when someone says it's a it's a gift to us as an organization, but it's a it's a gift to the world when someone says I'm willing to share my story in order to make this [00:20:30] this place a better place, um, in order to try and change things. 

And that's exactly what people say to us who are experiencing some sort of challenge accessing care they need. We ask people, would you be willing to share your story? [00:20:45] And for those folks who say yes, so often that's coupled with, I don't want other people to have to experience what I'm experiencing. And so I want to share my story so that we can put an end to this.[00:21:00]  

Or I want to share my story because this has been so hard for me, but I realize that I have certain privileges. And what about people who are in even more difficult situations than I am? The individuals who are bold and brave enough to share their [00:21:15] stories, they do so because they see themselves as advocates and they appreciate that sharing their story is a way to make change. 

And the work that we do with stories, it's, we, we get those stories out [00:21:30] on our website, on social media, but then we also work to share them with journalists and policy makers, because really those are the spaces in which change really [00:21:45] happens. And the Medicaid Unwind has been a tremendous example of the power of stories because this has really caught on this issue with the media and there's been a huge amount of [00:22:00] media coverage of the Unwind and the losses of coverage among families and children. 

And so amplifying these voices is giving a [00:22:15] human face to this policy challenge. And, and we all know that's, that's the way you tell a story effectively in order to make change.  

Atyya Chaudhry: Stories by those impacted are so important to help us understand the real life consequences of policy [00:22:30] decisions. Alison shares a few stories from individuals her organization has worked with. 

Alison Yager: There's a couple of stories I can share. One is a woman, Lily, and actually her story was picked up by the AP. Lily is a woman [00:22:45] who lives in Miami and she now has three kids, but when she was pregnant with her third, her pregnancy was high risk. So numerous extra doctor's appointments. And in the midst of all that, [00:23:00] she was trying to pick up extra hours at work to make up for income that she knew she'd miss after the baby was born. 

And she'd been on Medicaid since her third pregnancy began. Her two older sons were also on Medicaid. [00:23:15] She then was informed that the older one had become ineligible with the Unwind. And in response to that, she submitted an application to enroll him in Florida Healthy Kids, which is our CHIP program. [00:23:30] She reported in the application her and her husband's most recent income. 

And in response, she received a notice from our Department of Children and Families saying that she herself was no longer eligible for Medicaid, [00:23:45] even though her case was not yet up for renewal. So she got this notice being just weeks away from her due date. She sprung into action and she did her research. 

[00:24:00] She learned that once she had gone on to Medicaid for, with her pregnancy, that she should remain eligible, regardless of her income, throughout the duration of the pregnancy and for the 12 months postpartum, [00:24:15] because we now have 12 months postpartum Medicaid coverage in Florida. She, like so many other people, then found herself in this position of having to just be nonstop trying to reach DCF, Department of Children and Families. 

Atyya Chaudhry: Alison [00:24:30] continues on to share the details on Lily's story. The countless hours she spent on the phone and on the computer to get her insurance restored.  

Alison Yager: I want to just read a quote from her because she said, and this, she is an incredibly strong woman and so determined as you can [00:24:45] imagine through all of these travails. 

But she said, “There were days I cried and felt like giving up, but I knew I couldn't because my family needs me to be healthy, especially my unborn child. So I wiped my tears and kept calling. I just don't [00:25:00] understand why the state makes this so hard.” So, you know, it's, it's taken people so much perseverance and tenacity just to get. 

The coverage that they're in fact eligible for in so many cases because [00:25:15] the numbers of people being redetermined, the volume is so high that there is inevitably going to be error and we're dealing with an old antiquated computer system and so all of [00:25:30] these individual's lives are the casualties of this sort of overloaded system. 

And I can also share with you one more story from a woman named Christina. [00:25:45] Christina has four kids who range in age from six to 16. All of them are clearly eligible for Medicaid, but they were terminated in July. And she, Christina, spent [00:26:00] three months dealing with confusing and mistaken notices and this really dysfunctional call center and staff who just, were not properly informed. 

DCF [00:26:15] issued a notice terminating Medicaid for the entire family saying that they had failed to follow through with Medicaid renewal. And it took over a month to reinstate the kids, though they should have been reinstated [00:26:30] immediately.  

Atyya Chaudhry: Like Lily, Christina had to spend many hours navigating confusing notices and working hard to get insurance for her family again. 

A full account of Lily and Christina's story is available in the resources section of this episode. 

Alison Yager: She, Christina, was, has [00:26:45] a quote in, in, in the story we have on our website where she says, “I knew that stopping my son's ADHD medication abruptly would put his mental and physical health in jeopardy and make it much more difficult for him to succeed in school. 

Fortunately, a family [00:27:00] member stepped in to pay for the medications while I worked to get my children's health coverage reinstated.”  

She went on, she says, “you know, it's hard, it's hard enough to hold everything together without my children losing their health insurance for no legitimate reason. I did everything I was supposed to [00:27:15] do, but the state still pulled the rug out from under us. Not once, but twice. I live in fear that it will happen again. I love my children and I'm doing all that I can to help them grow up to be healthy, successful adults. I'm their mom. It's my job [00:27:30] to protect them.” So, you know, all of us who are parents can just relate to that so intimately and there's nothing most parents wouldn't do for their kids. 

And yet this unwind has put so many families. [00:27:45] In these really precarious positions unnecessarily causing so much stress returning to the value of, of doing stories work. We, our office worked really closely with a [00:28:00] reporter from the New York Times who ended up including Christina's story in a piece that he wrote about the Unwind and children losing coverage. 

And so having these relationships with folks [00:28:15] who are willing to say, yes, it's scary to tell my story, but there's also frustration and anger with a broken system. And [00:28:30] people want to use their voices when given the opportunity to say, how do we make change if I can share my story so that what happened to me doesn't happen to somebody else? 

So we've just been so fortunate to work with [00:28:45] so many incredibly brave people who, who want to take that step so that, so that fewer people have to suffer in the way that they have.  

Atyya Chaudhry: Alison has experience in maternal, infant, and reproductive health in New York City's Department of Health and Mental [00:29:00] Hygiene. 

With that lens, we'll wrap up by discussing the role of maternal and child health professionals in supporting families and communities now and also in the future as Medicaid redeterminations will continue. 

Alison Yager: Yeah, so I think so much of [00:29:15] this is about people knowing what to expect and knowing what their rights are, even when both of those things happen, we, there's no guarantee that the outcome will be correct for your clients, [00:29:30] whoever you may be serving and helping them know what they remain entitled to.  

So maybe that's working closely with social work staff if you're at a hospital or a facility with social work [00:29:45] staff. You know, this one individual who we worked with, she was pregnant and her coverage was terminated before the end of the 12 months of [00:30:00] postpartum of, of the postpartum period, well before the end of the 12 months. 

And, and she had seen a flyer that we had co-created with the March of Dimes. educating people about the 12 [00:30:15] month postpartum coverage and this kind of people who were covered by Medicaid in Florida and now had access to 12 months of postpartum coverage. And so she took this flyer to DCF, Department of Children and Families, [00:30:30] to say, look, this is, these are my rights. 

I'm eligible for this full 12-month postpartum period. Why was I terminated early? And because the postpartum extension happened [00:30:45] during the pandemic, um, and so it wasn't implemented immediately just because all Medicaid terminations were on hold. It seems from what we've been observing that DCF staff were not, at least not universally educated about [00:31:00] this. 

And so she went and spoke to numerous people who didn't know anything about the 12-month coverage, but she was, you know, armed with this flyer with this information from credible organizations. [00:31:15] And so she persisted until she got to someone who knew what she was talking about and knew that she was right, and they were able to turn things around. 

But so giving people access to the information about here's what you're [00:31:30] eligible for. And if your case is terminated. And properly, then know your rights, and I think it's really important for health care providers to know where they can refer people if, you know, if the [00:31:45] social work staff doesn't have capacity to be advocating directly with DCF or its equivalent in your state. 

Then, know who your legal services organizations are locally, know [00:32:00] who are the advocacy entities that you can connect people with and to the, to the best of your capacity, try for warm handoffs between the healthcare provider and the [00:32:15] legal advocate so that people don't get lost in one more word. Thank you. 

intake protocol. I think it's really then equipping people with that, that information and that ability to advocate for themselves and connect with [00:32:30] professional advocates as necessary. We know that this, this process is rife with error. And so people should not assume that what the state is telling them is correct. 

They should know what they [00:32:45] are eligible for, and then they should have access to, to resources who can help them find for that. There will be plenty of people whose cases are terminated properly and appropriately. There will be plenty of people whose cases are [00:33:00] terminated improperly and incorrectly. But for those whose cases are terminated appropriately, then another really important role is helping them to connect to a new form of [00:33:15] coverage. 

So, whether that's the CHIP program for their kids or getting and helping them connect to the marketplace, if they're eligible for marketplace subsidies, but to the extent [00:33:30] that there are alternative coverage options. helping them to know what those are and to find the ways to enroll there. And if there is no alternative option that's appropriate for that [00:33:45] individual or family, knowing where is a free clinic, where is there a charity hospital that I can access that where I'm going to be most likely to have low cost or no cost care. 

So [00:34:00] knowing those, those sorts of resources also to connect patients to is going to be really important. So I think there are, we've worked with so many incredible providers who have [00:34:15] redefined their jobs. And I know how strained you all are already, and I know this, this system is demanding so much of you as it is, but also know that when you have the time and [00:34:30] the desire to step out of the grind and advocate for your patients in a different way, those of us who are doing this, this work as you know, as, as lawyers or [00:34:45] organizers or whatever the case may be, welcome partnerships with you and are really eager to, to collaborate because you have a voice and a legitimacy that so many of us don't have and an authority that so many of us don't have. 

So [00:35:00] please know how powerful you are as an advocate. 

Maura Leahy: Thank you all for joining us on this MCH Bridges. We kindly ask that you take a few minutes to fill out a quick feedback survey. [00:35:15] And let us know what MCH-related topics you're interested in and who you want to hear from on future episodes, a link to the podcast feedback survey, as well as the transcript of this episode can be found at www.mchbridges.org. 

 [00:35:30] Be sure to follow AMCHP on social media. We hope this episode created some new connections for you stay well, and I hope our paths cross on the next MCH Bridges.[00:35:45]  

This project is supported by the Health Resources and Services Administration, or HRSA, of the U. S. Department of Health and Human Services, or HHS, as part of an award totaling 1,963,039 dollars [00:36:00] with 0 percent financed with non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, [00:36:15] or the U.S. government.