1 in 5 Arkansas children lost Medicaid during ‘unwinding’ process, report finds

About 20% of children insured in Arkansas’ Medicaid program lost access during the state’s “unwinding” period, according to a report released Thursday from the Georgetown University Center for Children and Families.

“Arkansas did move very aggressively, and I think you can see that reflected in their losses,” said Joan Alker, executive director of the Georgetown organization.

In six months, the Arkansas Department of Human Services disenrolled 184,500 people from Medicaid; more than half, 94,000, were children.

The report, which analyzed every state’s performance during the unwinding as of December 2023, ranked Arkansas with the sixth highest percentage decline in Medicaid coverage for kids. Arkansas’ rate more than doubled the nationwide average of 10%.

The end of a nationwide Public Health Emergency, which began due to the COVID-19 pandemic in 2020, forced states to complete an unwinding process and disenroll people who were no longer considered eligible.

DHS spokesperson Gavin Lesnick said though the team has not yet reviewed Thursday’s report, Arkansas followed the unwinding process as required.

“We believe that maintaining access to uninterrupted health coverage for children is critical to their health and well-being, and Arkansas has made significant efforts to ensure that every eligible child and family in the state maintained coverage.”

State officials had the authority to determine how fast the disenrollments occurred, and Arkansas was one of the first states to begin in April 2023. While Arkansas law required disenrollments to be completed by September 2023, other states chose to implement pauses and only recently finished their unwinding period.

“[Gov. Sarah Huckabee Sanders] was very clear that they were going to move quickly on this, and the legislature had also engaged on that question,” Alker said. “I think one of the issues that really was problematic in the way the governor’s folks talked about this was that … children are much more likely than adults to remain eligible for Medicaid. If you see large numbers of children losing [coverage], that’s a problem.”

According to the report, Arkansas was one of eight states that had fewer children enrolled in Medicaid after the unwinding than it did pre-pandemic. Down by 6%, the report stated the decrease was likely due to “red tape barriers.”

Lasting effects

The speed at which Arkansas disenrolled people from its programs received criticism from advocates who said it caused issues, such as Medicaid recipients being removed because of paperwork and procedural errors.

“If there’s an influx of work, [that] means more mistakes get made, more calls get abandoned, more people give up in the process,” said Tricia Brooks, a co-author on the report.

Advocacy groups, including Arkansas Advocates for Children and Families, called on DHS to extend or pause disenrollments. But because DHS pushed ahead, today’s work includes working in reverse to implement re-enrollments, said Camille Richoux, AACF’s health policy director.

“The ramifications of losing insurance for your kids are enormous,” Richoux said. “Without insurance, kids can’t get the crucial standard preventative screening treatments. It leads to delays in care.”

Under ARKids First, children in Arkansas can receive routine checkups, immunizations, eye exams and trips to the dentist. It can also cover mental or behavioral health care, X-rays and prescriptions.

Richoux said gaps in insurance coverage as a child can have a lasting impact into adulthood as it relates to life expectancy, future earnings and education attainment.

Going forward, Richoux said Arkansas Advocates for Children and Families recommends DHS take a more communicative approach to re-enrollments, which may include extending information to rural communities and to people whose first language isn’t English.