Arkansas Medicaid worked as designed in pandemic, faces challenges coming out of emergency

I’ve read a lot of columns recently that begin with the phrase, “If there’s one hard lesson we’ve learned from the pandemic ….” Well, this is not one of those columns, because I’m pretty sure we’ve learned a lot of hard lessons which we should all reflect upon and not repeat.

Instead, this column highlights a program that was designed to respond swiftly during emergencies and act as a major cog in our social safety net — Medicaid. A program that rode on the political coattails of the more popular Medicare program to make its way into the federal Social Security Act of 1965, Medicaid has had an integral and growing role in our nation’s health care system, covering about one in five Americans and serving as the principal source of long-term care coverage.

Even when the country is not in the middle of a pandemic, Medicaid is a critical part of the health care safety net. It ensures that people who don’t have affordable access to health care coverage through an employer or an individually purchased plan are able to access the care they need.

During natural disasters or public health emergencies, however, Medicaid plays an essential role in crisis response, even if that role is not as visible as the ones played by the Centers for Disease Control and Prevention during COVID-19 or the Federal Emergency Management Agency in the aftermath of Hurricane Katrina. Medicaid’s ability to quickly respond is possible because of its design and financing structure, a state-federal partnership that guarantees that the federal government will match state expenditures for eligible individuals, with no limitations.

Maybe we won’t experience another pandemic for a long time, but if we do, Medicaid was designed to stand up to the test.

In Arkansas, enrollment in Medicaid and the Children’s Health Insurance Program, a complementary program, grew from nearly 900,000 at the beginning of March 2020, just before COVID-19 arrived in Arkansas, to nearly 1.1 million in late 2021. In other words, the source of health care coverage for more than one in three Arkansans is through these programs.

The substantial increase in enrollment is due only in part to pandemic-related coverage demand. It’s also due to Congressional action early in the pandemic that protects enrollees from being terminated from Medicaid coverage during the public health emergency. Under normal circumstances, state Medicaid programs must assess whether a beneficiary is still eligible for coverage on at least an annual basis, with coverage for beneficiaries terminated if they are no longer eligible based on changes in income or other eligibility requirements.

As a result, Arkansas Medicaid officials will soon be faced with one of the largest administrative tasks in the program’s history — redetermining the eligibility of thousands of beneficiaries after years-long delays due to COVID-19. The public health emergency is currently set to expire April 22, 2022, although it could be extended since CMS has signaled it would give states 60 days’ notice before it ends.

Regardless, states are planning now for how they will manage this redetermination process and trying to anticipate major challenges ― and Arkansas Medicaid officials will have an especially short timeline: Although federal guidance gives states up to 14 months after the public health emergency to complete the eligibility redetermination process, Arkansas lawmakers passed a bill in 2021 requiring the state to complete Medicaid eligibility redetermination within six months of the end of the public health emergency.

Arkansas Medicaid officials have already announced the creation of a new call center to contact beneficiaries and help update key contact information. This effort is in anticipation of the upcoming redetermination process, which will require beneficiaries to complete renewal paperwork to continue receiving Medicaid coverage. Even so, state Medicaid officials have estimated at least a 30% disenrollment rate.

Smooth transitions for those who are no longer Medicaid-eligible are vital to prevent unnecessary loss of coverage and ensure continuity of care during the redetermination process after the public health emergency, particularly for those who are in the course of treatment for cancer, serious mental illness, or substance use. Targeted outreach efforts for vulnerable populations should be a priority.

Medicaid has worked as designed during the COVID-19 pandemic by providing needed care for those whose lives have been disrupted. As we move out of the public health emergency, let’s ensure that as a state we maximize the use of electronic data to renew coverage for those who remain eligible, commit sufficient resources to ease coverage transitions, and minimize administrative burdens for enrollees so that their health care safety net can remain intact.

Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.