Rural health providers prep for post-COVID Medicaid roll reduction

Arkansas rural health care providers are preparing for an uncertain future as the Department of Human Services begins disenrolling thousands of Medicaid recipients for the first time since the start of the COVID-19 pandemic.

The federal Consolidated Appropriations Act, signed into law last December, allowed states after March 31 to begin dropping Medicaid recipients who are no longer eligible or who have not responded to DHS communications to renew their benefits.

The state had 1.138 million Medicaid enrollees as of February, a 23.6% increase over March 2020, according to DHS’s “Arkansas Comprehensive Unwinding Plan.”

At a Rural Health Association of Arkansas conference Thursday (April 20), Rep. Jack Ladyman, R-Jonesboro, noted that all Medicaid beneficiaries will have to be reevaluated over a period of six months. He said it’s been projected that up to 300,000 Arkansans could be dropped from Medicaid for a variety of reasons, including that they have gotten better insurance at work. But some will fall through the cracks.

“A lot of people are going to lose their coverage. We know that. We don’t know how many,” Ladyman said. “This is also, or could be, a major impact on the state budget.”

Ladyman said lawmakers budgeted taking money from the Medicaid reserve to help meet the needs.

Ladyman, a former chairman and now member of the House Public Health, Welfare and Labor Committee, was part of a panel discussion that also included committee members Rep. Aaron Pilkington, R-Knoxville, and Rep. Mary Bentley, R-Perryville, as well as Sen. Fred Love, D-Mabelvale, a member of the Senate Public Health, Welfare and Labor Committee.

David Mantz, CEO of the Dallas County Medical Center in Fordyce, told the legislative panelists that hospitals will not turn away former Medicaid patients and will likely provide more uncompensated care.

Gov. Sarah Sanders told Talk Business & Politics in an interview that aired on the “Capitol View” television program April 16 that she could call a special legislative session to deal with Medicaid issues including disenrollment and also her administration’s request for a waiver allowing the state to include a work requirement for some recipients.

“I think it’s certainly possible that we could have a special [session], not a 100%,” she said. “I don’t want to just go in without a plan, and that’s what we’re working on right now, working with our partners in the Legislature to see what the best path forward is and how we address some of the cost and have a bit more cost containment and look for long-term sustainability. Because that’s what we need when it comes to our Medicaid program, and it’s certainly not the path that we’re on right now. So we’re digging deep and that’s a big priority for us over the next several months.”

The legislative panel occurred at the first conference of the Rural Health Association of Arkansas, which formed two years ago and now has about 350 members including rural hospitals and other healthcare-related entities. At the time it was formed, Arkansas was one of only six states without a rural health care association, said member Lynn Hawkins.

Hawkins said members are “extremely concerned” about the federal government’s ending of the required Medicaid enrollment period March 31. She said the system is challenged in its ability to re-enroll recipients whose mailing addresses and other contact information may have changed. Patients might not know they have lost their Medicaid until they show up at an emergency room in a rural hospital needing care. The cash-strapped hospitals will still serve them, but they will eat the costs.

“If you start having people show up with these major events, and then there’s no reimbursement for those hospitals who are already in severe distress financially, that’s a pretty major impact,” she said in an interview afterwards.

Ladyman said 51 of the 889 bills that became law in this year’s legislative session were health-related, with 10 potentially affecting rural hospitals.

Among the most significant was Act 59 by Rep. Lee Johnson, R-Greenwood, and Sen. Missy Irvin, R-Mountain View, which created the rural emergency hospital designation. The designation will be available for qualifying facilities that provide full-time emergency services and have a transfer agreement with Level 1 or Level 2 trauma centers. It provides hospitals a state pathway to qualify for a new federal rural emergency hospital designation where they could bill Medicare for outpatient services at 105% of the normal rate.

Among the other bills noted by panelists was Act 223 by Sen. Justin Boyd, R-Fort Smith, and Bentley that will allow hospital pharmacies to fill 31-day prescriptions for discharged patients. Bentley said the law will benefit rural residents like herself.

Pilkington said he was disappointed his House Bill 1010 requiring a year of Medicaid coverage for postpartum mothers did not pass, but he hopes the issue can be addressed if there is a Medicaid special session.

Love cited a new law, Act 713, that changes the system for disposing of used tires. He said while it may not seem like an important law regarding public health, tires are slow to decompose and become a magnet for standing water that can breed mosquitoes and spread disease.