AACF report: Medicaid red tape a barrier; navigators can help

Medicaid’s administrative processes often are a bigger barrier to beneficiaries receiving services than program eligibility issues, focus groups convened by Arkansas Advocates for Children and Families said. Investing in navigators and improving communication can help address those issues.

Those were some of the takeaways and recommendations from nine focus groups composed of Medicaid recipients that met from October 2025 to March 2026. Seventy-three participated in total.

The findings were released July 13 in a white paper, “Coverage, Care, and Consequences: Arkansas Medicaid Perspectives,” by AACF Health Policy Director Camille Richoux and Health Policy Associate Hayley Cormican.

The administrative process itself, not program eligibility, was the biggest issue facing beneficiaries.

“Participants very rarely discussed being ineligible as the primary barrier,” the authors wrote. “However, consistently, across all focus groups, participants described difficulties navigating the enrollment and renewal process. Nearly every participant described issues with either lost paperwork, missed notices, communication barriers, timing delays, and being treated poorly at DHS offices. Many participants felt they were required to repeatedly prove their eligibility or provide the same information multiple times. These findings suggest that administrative complexity, rather than program eligibility itself, is often what prevents people from obtaining or maintaining coverage.”

The authors recommended investing in navigators who can assist eligible beneficiaries in enrollment. Participants without access to enrollment help reported more challenges. Individuals in seven of the nine focus groups said assisting organizations including hospitals and community-based organizations made the process easier.

Other recommendations included better communication through multiple mediums; decreasing unnecessary administrative barriers and lengthy applications; increasing automated data sharing; reforming child support enforcement processes; and exploring reforms that would keep families from facing benefit cliffs. A benefit cliff occurs when a small increase in income causes a reduction or loss in coverage.

The report said it convened the focus groups in the wake of the passage of the federal One Big Beautiful Bill Act last year, which it said would result in cuts to states and losses to coverage. The law will result in eligible beneficiaries losing coverage because of paperwork and administrative barriers, the report said.

The report said that participants in all nine focus groups said Medicaid provides health coverage, financial stability, and peace of mind. It allows them to access care, medications, behavioral and substance use treatments, and emergency services. Some described it as a life-or-death benefit that possibly allowed them to survive to parent their children.

However, many raised concerns about services that weren’t covered or benefits that were limited. Many mentioned challenges with finding health care providers who accepted Medicaid. Many had to make difficult financial choices, including choosing between bills and expenses, because of coverage losses or eligibility issues.

“One participant who had lost their coverage due to an administrative error told us they stayed just two nights in the hospital to be sent a bill for $75,000,” the authors wrote.

Participants described a variety of administrative challenges. Mail and paperwork would get lost, and it could be difficult to communicate with Department of Human Services staff. Eligibility issues led participants in all nine groups to delay or forego care. Many participants did not know they had lost insurance until they were trying to access care. Members of almost every focus group relied on the emergency room because of eligibility issues and because of lost coverage. Many had knowledge gaps pertaining to coverage, eligibility and rules. One participant said they didn’t know if a service would be covered or if they would receive a bill. Benefit cliffs led individuals to limit work hours or feel pressure to decline raises. Many expressed concern about work reporting requirements.

“One individual explained the unnecessary difficulty of the application process as, ‘being on trial for a crime no one has committed,’” the report stated.