Disenrolled Medicaid recipients have grace period, can reapply afterwards

by Steve Brawner ([email protected]) 1,176 views 

Arkansas’ Medicaid program announced Monday (May 8) that it had disenrolled 72,802 individuals – the first major removal in three years that is occurring because of the end of the COVID-19 public health emergency.

But qualifying individuals who lost coverage – many because they didn’t return the renewal form – can be reinstated during the current grace period, and those who continue to qualify can rejoin the program later.

Individuals who lost their coverage under the state’s ARHOME program have 30 days to be reinstated with no effective gap in coverage if they still qualify for long-term services and supports because of a condition or disability, while those covered because of income-based reasons have 90 days.

“For everybody right now that lost coverage in this first month of redetermination, they right now can send in information they didn’t before and have their case reinstated,” said Arkansas Department of Human Services spokesman Gavin Lesnick.

Moreover, if an individual lost coverage and then goes to a medical provider in the future and still qualifies, they can reapply for coverage and have that visit retroactively paid for. Coverage can be applied retroactively going back 30 days for individuals receiving services through the state’s ARHOME program and 90 days for those receiving services through traditional Medicaid.

Individuals seeking to reinstate coverage can go to ar.gov/renew or call 855-372-1084.

Arkansas stopped disenroling most Medicaid beneficiaries after former President Trump on March 18, 2020, signed the Families First Coronavirus Response Act. It increased federal Medicaid matching funds for states that kept all individual cases active during the public health emergency.

DHS this month started making the removals as a result of the federal Consolidated Appropriations Act, signed into law by President Biden last December. It allowed states after March 31 to begin dropping Medicaid recipients who are no longer eligible, a process known as “unwinding.” Normal eligibility rules, set by Congress and the Centers for Medicare and Medicaid Services, resumed April 1. All beneficiaries who have not had a renewal in the last 12 months will be redetermined. State law requires that the work be completed in six months.

DHS said it disenrolled 44,667 Medicaid beneficiaries whose coverage had been extended because of the COVID public health emergency in the month of April. Another 28,135 cases were closed as part of DHS’s normal operations, bringing the total for the month to 72,802.

By far the most common reason for closing a case was the failure of recipients to return the renewal form. That was 44,714 total cases and included 35,625 extended cases and 9,089 regular cases.

Medicaid provides government-funded health insurance for lower income individuals and others. Some are covered through traditional Medicaid. Others with incomes up to 138% of the federal poverty level can receive private insurance paid for by the government through the ARHOME program.

Some of the disenrolled individuals will not continue to qualify for Medicaid because their incomes were too high, because they aged out of a program, and for other reasons. Those individuals would be eligible to purchase private insurance through the health insurance marketplace.

The federal Centers for Medicare and Medicaid Services announced in January that it was creating a special enrollment period for individuals who have lost their coverage because of the unwinding. The special enrollment period will last from March 31, 2023 to July 31, 2024. Coverage would begin on the first day of the month after the individual selects a plan.

A DHS press release said the department expects enrollment to continue to decline in the coming months. Enrollment is still 145,475 beneficiaries higher than it was at the beginning of the pandemic. It was 921,066 on March 31, 2020. On May 1, it was 1,066,541.

The state’s Medicaid population increased by 230,000 total during the pandemic.

“It’s about rightsizing the rolls,” Lesnick said. “We need to make sure that Medicaid is serving people who are eligible for it, and ensure that we’re connecting those who aren’t eligible for other coverage that they do qualify for, like an employer plan or a marketplace plan.”

The other reasons for closure were as follows.

  • Failure to return requested information: 7,673 total; 1,596 extended; 6,077 regular
  • Client requested closure: 5,791 total; 2,685 extended; 3,106 regular
  • Household income is above limit for household size: 5,414 total; 1,485 extended; 3,929 regular
  • Unable to locate – returned mail: 2,024 total; 739 extended; 1,285 regular

Loretta Alexander, health policy director for Arkansas Advocates for Children and Families, said individuals might not realize they can reapply, or they can be overwhelmed by the process and not complete the paperwork. Others including members of the Marshallese and Hispanic communities have language barriers. People often simply don’t reapply, which can affect their children. In this first month of the unwinding, 29,067 of the individuals who lost coverage were covered by the state’s ARKids First A, ARKids First B, and newborn programs.

Alexander, who said she was not being critical of DHS, said some beneficiaries are “living on the edge” with multiple challenges. They may be couch-surfing in the midst of housing transition issues. They may not live at the same place where they receive their mail, and the person who lives there may not give it to them.

“They may have more things going on in their lives at that point than reading information from DHS and getting it turned back in right away,” she said.