Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, provides coverage to over 1 million Arkansans. (Getty Images)
Health insurance coverage for hundreds of thousands of Arkansans will soon be at risk as health officials prepare for the first-of-its-kind review of state Medicaid rolls.
The number of Arkansans on Medicaid grew 20% during the pandemic, but some of those recipients are no longer eligible.
They remained covered under the nation’s largest public health insurance program, an afterthought of Congress’ first coronavirus relief law, but the Arkansas Department of Human Services — the state agency that oversees Arkansas’ Medicaid program — will for the first time in its history review the eligibility of all Arkansans on Medicaid in just a matter of months after the federal Public Health Emergency ends, whenever that may be.
(The Biden administration did not warn states on Monday that the emergency would end in mid-October, meaning it will likely be extended until at least January.)
Agency officials have already started laying the groundwork, mailing letters and making calls to ensure Medicaid recipients’ contact information is current.
Still, advocates are worried.
Who qualifies for Medicaid?
Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, provides health coverage to over 1 million Arkansans, including low-income adults, children, pregnant women, elderly adults and people with disabilities.
Eligibility is based on variety of factors that include income, resources and residency.
Non-disabled adults between the ages of 19-64 with incomes up to 138% of the federal poverty level ($18,754 for an individual and $38,295 for a family of four) may qualify for ARHOME, Arkansas’ Medicaid expansion program. Children and teens up to the age of 19 in families with incomes up to 211% of the Federal Poverty Level ($55,914) may qualify for ARKids First.
You can also contact the state’s Medicaid helpline at 1-800-482-8988 or reach out to your local Department of Human Services county office.
Will newly ineligible people seamlessly transition from Medicaid to private coverage?
Will some eligible beneficiaries get lost in the bureaucracy and mountains of paperwork?
“Caught up in the churn is what I call it,” said Trevor Hawkins, an attorney for Legal Aid of Arkansas who represents individuals on Medicaid. “I think there’s a very high probability there will be a mess.”
The situation was created by Congress’ first coronavirus relief law enacted in March 2020. It offered states a sweet deal that all accepted: The federal government would kick in extra Medicaid money so long as states agreed not to kick anyone off the program during the Public Health Emergency.
Nearly two-and-a-half years later, the emergency remains in effect, and several groups estimate that between 15-16 million Americans on Medicaid are now ineligible.
In Arkansas, the data is even less clear, although as of Aug. 1, almost 350,000 Medicaid recipients in the state had seen their coverage extended due to the Public Health Emergency.
The overall state Medicaid rolls jumped from 923,148 in February 2020 to 1,118,566 as of June 30 — a 21.2% increase.
DHS officials estimated in January that 30% of Medicaid recipients, roughly 335,500, could be disenrolled during the redetermination process.
Gavin Lesnick, the chief DHS spokesperson, said last week that the agency didn’t have a strong, current estimate.
“While we have considered different scenarios, we do not have an estimate specific to Arkansas at this time,” he said.
One study funded by the Robert Wood Johnson Foundation and referenced by the Centers for Medicare and Medicaid Services “estimated 15 million people in the U.S. are likely to lose Medicaid coverage across the country once the Public Health Emergency ends,” Lesnick said.
“We can provide the total number of clients who have had their coverage extended because of the [Public Health Emergency], though it is important to note that this is not an estimate of who will lose coverage.”
A short window
DHS has never before had to conduct this many coverage “redeterminations” in such a short period, Lesnick said.
The agency has six months to do the work (in addition to normal eligibility and application reviews) thanks to a state law passed last year.
While the federal government would allow a year for the coverage reviews, the Arkansas General Assembly voted to shrink the timeframe to six months.
The bill was pitched as a fraud-reduction measure.
“The State of Arkansas has lost millions of dollars to waste and fraud in its welfare programs,” the bill’s legislative findings section reads. “Inadequate eligibility verification policies have failed to maintain program integrity. As demand for public assistance remains high due to economic uncertainties and closures related to the COVID-19 pandemic, protecting limited resources for the needy is critical.”
In Kansas, health officials plan to take the full year for Medicaid eligibility redeterminations, fearing a shorter window would overwhelm staff.
To prepare for the rush, Arkansas Medicaid officials in March began calling Medicaid recipients to ensure their contact information was accurate. A report from the Center for Budget and Policy Priorities praised the outreach as an “innovative” approach other states should copy. The center describes itself as a nonpartisan Washington D.C.-based think tank.
As of July 17, DHS had tried to call 281,497 individuals whose coverage has been extended due to the public health emergency. Through those calls, the agency confirmed or updated 39,106 addresses.
Beneficiaries can also update their contact information by calling the Update Arkansas hotline at 1-844-872-2660 or visiting DHS’ benefits site.
The agency has used social media and traditional advertising to reach Medicaid recipients whose coverage will be reviewed. State officials have also enlisted the help of Medicaid providers and other stakeholder groups to reach out to those beneficiaries.
Next, Medicaid recipients will receive renewal forms by mail. Those forms can be delivered to DHS by mail or in person; renewals can also be completed online.
“Medicaid recipients who remain eligible should expect to keep their coverage by updating their contact information now and returning their renewal information,” Lesnick said. “Medicaid recipients do not have to wait until the emergency ends to return their renewal information, as DHS has continued and will continue to send out and process renewal packets during the [public health emergency].”
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'Imagine being someone who needs quick approval'
The monumental task comes as DHS still struggles to keep pace with new Medicaid applications. At the end of July, 265 health-care applications were more than 90 days old; 655 were more than 45 days old, according to agency data.
That’s down from a backlog of 50,000 Medicaid applications in November that prompted state lawmakers to allocate $29 million to address it. The agency hopes to have cleared the remaining backlog before the end of the federal emergency.
Loretta Alexander, health policy director for Arkansas Advocates for Children and Families, worries about delays for all those dependent on Medicaid.
“Everybody on Medicaid will have to be reevaluated after the public health emergency ends,” she said. “On top of that, they’re still taking new applications that will be delayed. Imagine being someone who needs quick approval, like pregnant women or an elderly person in the hospital needing to switch to a nursing home.”
Alexander also noted that many Medicaid recipients move residences often, particularly during the pandemic, so many may be difficult for DHS to track down.
She commended the agency for offering renewal material in several languages, including Spanish and Marshallese.
Medicaid recipients and advocates are still wary of the state after the flawed implementation of Arkansas' Medicaid work requirement four years ago.
The requirement, which was first implemented in June 2018, applied to a certain group of able-bodied adults covered under Arkansas Works, then the name of the state’s expanded version of Medicaid that since 2014 has covered Arkansas who earn up to 138% of the federal poverty level.
More than 18,000 Arkansans lost health coverage because of the work requirement, which a federal judge struck down in March 2019. Several studies concluded that some lost coverage because of difficulties with the DHS online reporting system, which was described as “clunky” and “not user-friendly.”
DHS has since redesigned the site, which can be used to apply for Medicaid and manage related benefits.
“That system created so many false notices,” Hawkins said. “That’s what this unwinding process is going to be.”
DHS learned several lessons from the work requirement’s implementation that it can apply to the upcoming unwinding, Lesnick said, like contacting recipients in multiple ways, involving providers and community organizations as well as providing a website where beneficiaries can manage their benefits.
Hawkins said that, of all the Medicaid recipients he works with, he doesn’t know any who no longer qualify for coverage. Some have told him that they thought the calls from the Human Services Department seeking updated contact information were spam calls. Others were unaware of the review altogether.
“It’s meaningless to people right now because they’re still getting Medicaid,” Alexander said. “It will be more meaningful when it actually starts to happen and people lose coverage."
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