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Nearly 35K more Arkansans lose Medicaid coverage due to incomplete paperwork


Nearly 35K more Arkansans lose Medicaid coverage due to incomplete paperwork

Jun 08, 2023 | 7:36 pm ET
By Tess Vrbin
Nearly 35K more Arkansans lose Medicaid coverage due to incomplete paperwork
Arkansas Medicaid recipients gather on the Capitol steps on Thursday, June 8, 2023, to describe their concerns with the state's administration of Medicaid and the ongoing "unwinding" of extended coverage after the COVID-19 public health emergency ended in May. (Tess Vrbin/Arkansas Advocate)

Nearly 35,000 Arkansans were dropped from the state’s Medicaid program in May because they did not provide required information to determine if they remained eligible for coverage, the Arkansas Department of Human Services announced Thursday.

May was the second month of disenrollments as DHS reviews the eligibility of about 420,000 Medicaid enrollees who had their coverage extended over the last three years due to the COVID-19 pandemic. More than 40,000 Arkansans lost Medicaid coverage in April because their eligibility was left unknown.

The disenrolled clients — 40,497 in April and 34,724 in May — either failed to return a Medicaid renewal form, failed to submit additional required information or were unable to be reached by the department, according to DHS data.

More than 1 million Arkansans, about a third of the state’s population, receive Medicaid benefits, and 39,848 Arkansans had their Medicaid coverage renewed in May, according to DHS data.

Of the 43,385 beneficiaries newly disenrolled from coverage in May, 5,354 now earn too much money to receive Medicaid and 3,307 asked to be removed, DHS’ report states.

DHS officials have also noted that some beneficiaries may not return the requisite paperwork when they know they’re no longer entitled to benefits.

As part of the federal government’s pandemic relief measures, Medicaid recipients were allowed to maintain coverage under the public health insurance program as of March 2020, even if they no longer qualified for the benefit due to income or other eligibility limits. The nationwide Public Health Emergency (PHE) enacted at the start of the pandemic ended May 11, and states have been “unwinding” the coverage extension since April.

Since then, more than half a million people in 11 states have lost Medicaid coverage, often due to incomplete paperwork.

This unwinding has concerned the advocacy group Arkansas Community Organizations. The group has repeatedly petitioned DHS for broader health care coverage from Medicaid, a less cumbersome application process and better customer service.

You shouldn’t have to be half dead to get your medicine.

– Michelle Perrian of Pine Bluff, whose insulin is not covered by Medicaid

A 2021 Arkansas law gives DHS six months to complete its eligibility review. Many other states have one-year grace periods that started April 1, allowing Medicaid enrollees to confirm during that time whether they are still eligible for coverage.

Arkansas Medicaid recipients asked in March for a one-year grace period to no avail. They repeated this and other concerns Thursday outside the State Capitol in Little Rock.

Clients can renew their Medicaid enrollments online or by mail to determine whether they are still eligible for coverage.

Problems with the system

Some Medicaid enrollees have struggled to submit their information to DHS, organizer Joyce Means said Thursday.

“When they hear back from DHS, they get a letter saying that their information wasn’t received and that they need to renew, when they indeed have renewed,” she told reporters.

Means said DHS notified her in March that she would lose Medicaid coverage at the end of the month. She ended up on another coverage plan in April that meant she owed medical copayments she did not owe previously, she said.

DHS then told Means the new plan would end April 30, and she is now trying to find out if her current plan ends June 15, she said. She compared her predicament to a bouncing yo-yo.

“Pull the string and it goes up, drop it and it goes down,” Means said. “That’s how my Medicaid [experience] has been.”

Michelle Perrian of Pine Bluff said DHS denied her Medicaid coverage for insulin because her diabetes is neither type 1 nor type 2, she said.

“You shouldn’t have to be half dead to get your medicine,” Perrian said. “…I just feel that it’s unfair that I have to go through this.”

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Crystal Alexander-Berry, a mother of two, said DHS’ system has incorrect information about her income and employment despite her attempts to change them.

“They said they were going to cut me off my Medicaid due to me making too much income, but there’s a glitch in the system that’s putting double the income in there,” Alexander-Berry said.

Every county in Arkansas has a local DHS office, but these offices cannot fix problems in the records kept at DHS headquarters, head organizer Neil Sealy said.

Al Allen, another organizer, said Arkansas Medicaid needs a “navigator program.”

“Clearly if these systems can’t function well enough on their own, we need a human with a heart to go in and see what’s happening to people so we’re not cutting coverage unnecessarily,” Allen said.

DHS has “safeguards in place” to try to prevent disenrolling people who still qualify for Medicaid, according to the department’s report on May’s unwinding data.

“Depending on their type of coverage, beneficiaries generally have 30 or 90 days after closure to provide the necessary information and have their coverage reinstated without any gap,” the report states. “Even if a beneficiary learns that coverage has ended after this window, he or she can reapply and, if eligible, may have retroactive coverage going back to the date of re-application.”

Recommended changes

Sealy said the letters that some Medicaid clients have received from DHS contain too much jargon, and several Medicaid recipients said in a survey released Thursday that they have been confused by the information they received from DHS both over the phone and in letters.

More than 400 Medicaid recipients throughout the state responded to the survey in 2022. Several said Medicaid coverage has been life-changing and life-saving, while others said the program has been a burden.

“It’s virtually impossible to follow all the requirements,” one person said. “Everything requires computer access and smartphones. It feels like they are just trying to find ways to kick us off.”

The respondents’ recommendations to DHS include hiring more staff to process applications and renewals; expanding Medicaid coverage to include dental, vision, mental health and tele-health care; increasing reimbursement rates for medical professionals who work with the program; and implementing 12-month continuous eligibility regardless of enrollees’ changes in income.

DHS Secretary Kristi Putnam met with representatives from Arkansas Community Organizations in February to discuss Medicaid recipients’ needs. Sealy said the group hopes to meet with Putnam again and continue their discussions.

Putnam was appointed to her position in January, and she was a proponent of Kentucky’s proposed Medicaid work requirement when she worked for the state’s Cabinet for Health and Family Services from 2016 to 2019.

In 2019, a federal judge struck down both Kentucky’s proposal and Arkansas’ work requirement that cut 18,000 people from Medicaid coverage.

Last week, Gov. Sarah Huckabee Sanders’ administration petitioned the federal Centers for Medicare and Medicaid Services for an amendment to the state’s Medicaid expansion program. The changes would provide the broadest coverage option to Medicaid recipients who work, volunteer, go to school or receive workforce training.

Able-bodied adults who do not meet the work or volunteering standards would not lose Medicaid coverage, but they would receive fee-for-service coverage instead of a private, qualified health plan, according to the proposal.

Qualified health plans meet the federal Affordable Care Act requirement for “minimum essential coverage” and follow federal limits on deductibles, copayments and out-of-pocket maximum amounts. Under fee-for-service coverage, the state pays health care providers for services rendered.

Health and legal organizations have criticized the proposal, saying Medicaid clients might lose access to the health care providers and resources that best suit their needs if they are forced to transition from qualified health plans to fee-for-service coverage.