Termination Notices Sent To 25,000 Private Option Recipients

Arkansas Medicaid officials have sent notices of termination to 25,000 Medicaid beneficiaries, almost all of them recipients of the state’s private option, informing them that they are losing their eligibility because they did not respond to a request for income verification, legislators were told Thursday.

Department of Human Services Director John Selig told members of the Health Care Reform Legislative Task Force that about 65,000 beneficiaries, again, nearly all of them private option recipients, have been determined still to be eligible.

The state will re-determine eligibility for 600,000 private option and traditional Medicaid beneficiaries and has actually begun the re-determinations for 225,000 of them.

Medicaid is the government health care program for the aged, disabled, and the poor. The private option was created by legislators in 2013 to use Medicaid dollars to purchase private insurance for lower-income Arkansans who make too much money to qualify for Medicaid. The task force was created earlier this year to study how to reform both along with the rest of the state’s health care system.

Recipients must certify their income eligibility if data indicates their income has changed by at least 10%. Selig said recipients are sent a notice saying they must contact the Department of Human Services within 10 days. The department typically adds another five days to be certain they have had time to respond. After no response, recipients receive a notice that their coverage will be terminated by the end of the month, but they must be given at least 10 days for that to occur. If terminated, recipients by law have 90 days to be reinstated, with medical charges covered retroactively.

Because the process is so new, few recipients have had their coverage completely terminated so far, Selig said.

Selig told legislators that the state Medicaid program is struggling to help Arkansans who contact it for help, explaining, “Our customer response system is overloaded because we’re doing so many re-determinations right now.”

Legislators also heard from an Arkansas resident who had faced difficulty being enrolled in Medicaid after she lost her job. That was frustrating to some, including Rep. Charlie Collins, R-Fayetteville, who complained about the difficulty for some to enroll in Medicaid at the same time that many people are receiving benefits for which they are not eligible.

Selig conceded that there have been problems but added that the program has more than 60 categories of Medicaid eligibility with hundreds of thousands of recipients, so problems with only a small percentage of enrollees still involve many people.

John Stephen, managing partner of The Stephen Group, which is consulting with the task force, said the state is not doing enough outreach to make sure it isn’t paying for people who are not eligible. He suggested the state request more frequent income verifications in a federal waiver.