KHELI Muhammad was trying to schedule a routine pediatrician's appointment last summer when she discovered that her 2-year-old son, who has a congenital heart disorder, had been kicked off the Medicaid rolls.
The 30-year-old mother of two boys was stunned.
"It is written in stone that he's covered," Muhammad said of Samad, who qualifies for Medicaid based on his serious medical condition, not the family's income level. "He's pacemaker-dependent . . . [H]is heart will not beat without a pacemaker."
But the heartbeat of the fragile little Samad was clearly not a priority for welfare officials, who informed Muhammad that she had failed to renew his benefits - even though she said she had not received renewal paperwork in the mail - and that she'd have to reapply.
It took the frantic mother a week to get her son - who has frequent doctor's appointments and needs special medications - back on the books.
"I didn't even get a notice that he would be canceled," said Muhammad, who lives in Overbrook with Samad and her husband and an older son. "Nothing had been sent to my house. Because of my son's condition, it's not something that would have slipped by."
Samad Muhammad is not the region's only kid to wake up without health-care coverage in recent months. At least 89,000 children vanished from the state Medicaid rolls between August and January - roughly 25,000 of them in Philadelphia, according to the state Department of Public Welfare.
Most of those kids - about 71,000 statewide - were removed as part of a massive effort to clear a backlog of recipients whose paperwork was not up to date, according to DPW spokeswoman Anne Bale. Medicaid recipients must file paperwork to renew their eligibility every six months, upon receiving documents from DPW.
But many of the children were wrongfully kicked off, and 23,180 have been reinstated in the program so far.
The drastic swing in Medicaid enrollments has prompted a furious debate in Harrisburg over Republican Gov. Corbett's budget proposal for next year, which includes a $629 million cut in social services while providing tax breaks for businesses.
Corbett's top public-welfare official has said he simply is trying to get ineligible people out of the program. Critics say Corbett is prepared to cut welfare costs by any means necessary.
"There's a reduction in revenues, and the wealthiest folk in the commonwealth get tax breaks and poorest folk get jammed, and jammed needlessly," said state Sen. Vincent Hughes, a Philadelphia Democrat and frequent Corbett critic.
Medicaid is a state- and federally funded program that provides health-care coverage for low-income people and for those with qualifying medical disabilities. Medicaid accounts for about $19 billion of the Welfare Department's $28 billion budget in the current fiscal year, according to DPW data.
The fall-off in Medicaid enrollments started last summer, when a large number of families were sent renewal paperwork and instructions to respond within 15 days. According to advocates, it appeared that if the paperwork was not then received and processed in time, those enrolled were dropped - even if the delay was the fault of DPW. And some families, like Muhammad's, have said they never got any renewal paperwork.
During a budget hearing in Harrisburg in February, lawmakers from both parties questioned Corbett's welfare secretary, Gary Alexander, about the children taken off Medicaid. Alexander said officials had simply reviewed a backlog of cases, which are supposed to get semiannual reviews, to ensure that no one was improperly receiving benefits.
"This is a procedure and a law and a regulation that's been in place for many years. All we're doing is enforcing it," Alexander told the lawmakers.
DPW declined to make Alexander available for an interview. Instead, the Daily News was referred to spokeswoman Bale.
She said that DPW has not been trying to remove the eligible from Medicaid.
"We have asked caseworkers or the people who have been wrongfully kicked off [to reach out]. We have continually asked to get this evidence and we don't get it," Bale said. "If anyone does feel they are wrongfully removed from Medicaid, they can appeal our decision."
Bale could not provide many details for why children had been removed from Medicaid. Legitimate reasons would include a change in the family's income, a move out of state, aging out or death. According to data provided by DPW, most of those reinstated on Medicaid had been dropped for "failure to provide information."
Colleen McCauley, health-policy director for Public Citizens for Children and Youth, said it was impossible to know why all the children had been dropped but that the group's hot line exploded with calls from people who said they had submitted the necessary paperwork and had been dropped without notification - as well as from people who contended that they had never been mailed renewal paperwork.
"We're hearing about children then having to rely on emergency-room care," McCauley said. "We're hearing about children who couldn't get ready for school like they needed to. They couldn't get their updated immunizations; moms were worried they couldn't go to school."
According to the Delaware Valley Healthcare Council, which gathers hospital data, ER visits at Philadelphia's two children's hospitals jumped in November and December 2011, compared with the previous year. A spokeswoman for the organization could not say how many of the visits were attributed to children who had been knocked off the Medicaid rolls.
McCauley said she worried that the motive for moving kids out of Medicaid isn't simply to remove those ineligible.
"We have grave concerns that by putting families through this review process and removing 90,000 children, that there is underneath it an effort to reduce . . . expenses," she said.
DPW officials have admitted as much. Alexander said in a presentation to the Legislature on Feb. 7 that "cost containment" was a major priority of the department, noting that Pennsylvania spends more of its budget on Medicaid than 48 other states.
DPW's budget accounts for about 41 percent of Pennsylvania's total budget. Officials say that growth in Medicaid spending has outstripped population and economic growth over the past decade and that such spending is unsustainable. The bulk of Medicaid spending goes to the elderly and to people with disabilities, according to data on the DPW website.
Hughes, ranking Democrat on the Senate Appropriations Committee, suspects that something more sinister may be going on at DPW, saying that the Corbett administration had launched a "war on poor folk."
He said that despite the lingering effects of the recession, the Corbett administration has decided not to raise revenues and instead is doling out hundreds of millions in tax breaks for corporations.
Hughes cited the administration's phaseout of the capital stock and franchise tax, which, according to the governor's proposed budget for next year, is expected to bring in almost $250 million less than this year. Businesses have long complained about the tax, saying it amounts to double taxation. Corbett has said the tax, to be phased out by 2014, is a drag on job creation.
Bale insists that the administration is not trying to go after the poor.
"It has nothing to do with targeting any type of population," Bale said. "We are simply doing our jobs, following the law. If people are ineligible for Medicaid, we can't afford to have them on the rolls."
The families of children who lost benefits complained of long waits and poor service at county welfare offices, saying that it was difficult to get a face-to-face conversation with a caseworker.
Staffing in the county offices has declined, according to data provided by DPW, with 1,448 staffers and 102 vacancies in the Philadelphia offices, compared with 1,496 staffers and 85 vacancies in June 2010.
Bale said all areas of government have lost staff.
Zoraida Mendez found out she had lost Medicaid coverage for her two step-granddaughters after she tried to get them an appointment for counseling.
"They need therapy," said Mendez, 49. "Why would they take away their medical?"
Mendez, who cares for the two girls and their baby sister with food stamps and $1,128 in monthly Social Security checks, said the family, which lives in the Fairhill section of North Philadelphia, couldn't survive without medical coverage for the kids.
Mendez spent days trying to fix the situation, but found success only after she was put in touch with Public Citizens for Children and Youth. She complained of low staffing and little personal attention at her county welfare office.
"When you go there now, you don't have a caseworker," she said. "They never find a caseworker."
Earlier this year, child advocates met with Alexander, the welfare secretary, about the children being moved off Medicaid. McCauley said that they wanted all the children reinstated for a period of time, pending a more-thorough eligibility review, but that the state refused.
Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project, said "there has been no systemic response" to the problem. "If a client got the paperwork in and it's just sitting around and then some child is disenrolled, it's a tragedy."
Bale said the state wants to hear from people who think their children have been wrongfully removed.
"We certainly want them to contact us so that we can remedy the situation," Bale said. "We want to know about them."