DHS implements changes to speed Medicaid, private option eligibility

The Arkansas Department of Human Services implemented two changes to its income verification system for Medicaid and private option recipients Monday, allowing it to process more than 3,000 cases.

Mark White, DHS deputy director, told members of the Health Reform Legislative Task Force Tuesday that DHS will use the data from income verifications already performed for beneficiaries of the Supplemental Nutrition Assistance Program, or SNAP, which is verified every six months. DHS also will rely on state workforce data to verify incomes. It began using these processes Monday for new cases and will begin using them for pending cases next week.

The task force will present proposed changes to Medicaid and the private option by the end of the year. Medicaid is the state-run program for the state’s poor, aged and disabled residents. Through the private option, the state purchases private insurance using Medicaid dollars for Arkansans with incomes of no more than 138% of the federal poverty line.

DHS is required by the federal government to finish the current verification for enrollees before Dec. 31, but it has run into major problems. Costs for a computer system have reached $200 million, more than twice the original expected amount. Earlier this year, DHS gave recipients 10 days to respond to a request for income verification, with an opportunity to appeal. After tens of thousands did not respond in time, the federal government issued new guidance requiring DHS to increase the time to 30 days. A consultant hired by the task force, The Stephen Group, reported in October that 42,891 Medicaid and private option recipients had best addresses that were out out of state, while 495 recipients were deceased before they joined the program.

So far, 60,952 cases have been terminated as part of this year’s eligibility verification process, most because they did not respond to a request for income verification. White said that 15,888 Medicaid and private option recipients have been reinstated into the program, leaving 45,064 dropped from the program. White said if the changes had been in place this summer, many of those dropped would have been verified.

The 3,344 individuals processed Monday had become eligible for their annual redetermination in the past month, White said afterwards. He said about 20 others were found ineligible because their income was too high.

Moving forward, he said the key metric for determining success will be the “no-touch rate” – the cases the system handles automatically. That rate has been about 20%, which he said is expected to be higher with the new processes.