Medicaid recipients to begin losing coverage after April 30

Ineligible Arkansas Medicaid beneficiaries will lose coverage for the first time in three years after April 30 as Arkansas exits the COVID-19 public health emergency.

The Department of Human Services this month started making the removals as a result of the federal Consolidated Appropriations Act, signed into law last December. It allowed states after March 31 to begin dropping Medicaid recipients who are no longer eligible.

All beneficiaries who have not had a renewal in the last 12 months will be redetermined. State law requires the work be completed in six months.

Amy Webb, director of the DHS Medicaid Control Center, said the federal government allowed the state to begin doing the redetermination work in February. The first round of renewals went out Feb. 11. Further renewals were sent out in March and April.

Webb is coordinating the Arkansas Medicaid program’s public health emergency wind-down efforts. She along with Mary Franklin, director of the DHS Division of County Operations, spoke at a webinar April 21 sponsored by Arkansas Advocates for Children and Families.

Arkansas stopped disenrolling 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.

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” that month.

Franklin said the state did continue to process applications and renewals throughout the three years but kept individuals enrolled even when their incomes exceeded eligibility limits, when they didn’t respond to DHS communications, when their level of care for long-term supports changed, or when they aged out of eligibility. Cases were closed when individuals died, were incarcerated, moved out of state, or asked to be removed.

Franklin said the state will try to do a renewal before closing any extended cases – meaning they kept their coverage even though they were considered ineligible – because individuals’ circumstances may have changed. She said that because the state has been processing renewals throughout the pandemic, most beneficiaries are not considered to be extended.

Webb said the department has set goals that the redetermination process be accurate and timely, with minimum disruptions for beneficiaries and providers. Personnel have looked at notices sent out to beneficiaries to make the language plainer and easier to understand.

“This is a huge undertaking. It is historic and unlike anything anybody, any Medicaid program in the country has ever done, so there are going to be bumps in the road,” she said. “It is not going to be perfect, but our job and our goal is to make sure that when we see those issues, that we react quickly and we fix them and we try to be proactive wherever possible.”

Webb said that while large numbers of individuals will lose coverage, they will be presented with options. For those who now exceed income limits, their insurance information will be sent to the federal Health Insurance Marketplace so they can be contacted. The qualified health plans that cover the state’s ARHOME program recipients will be given a list of their newly ineligible clients so they can contact them with marketplace options. They can also switch to employer-sponsored health insurance.

DHS began ramping up its preparations for the unwinding in January 2022. It has tested its systems through a variety of scenarios to ensure it is sending the right notices and taking the right actions. Testing will continue throughout the process. More than a year ago, it contracted temporary workers to help with eligibility determinations.

Webb said the agency knows it has a lot of bad addresses. Last summer, it began focusing on the issue. The agency called everyone that was determined to have extended coverage for whom it had a number. The department attempted more than 700,000 contacts and has been able to update or confirm correct addresses for 160,000 people. DHS obtained several federal waivers making it easier to update addresses, including one allowing it to use the United States Postal Service’s national change of address database.

Certain groups have been given special attention. Packets have been hand-delivered to vulnerable extended clients by nurses they know and trust. Lists were sent to skilled nursing and assisted living facilities so they would know who was at risk of losing coverage. Attention is being placed on clients who are pregnant, undergoing dialysis, and undergoing cancer treatments.

The agency has stepped up its advertising and communications and has started a grant program to work with about two dozen community-based organizations.

“We’re really trying to be nimble and respond to people and address concerns when we see them,” Webb said.

Last week, Gov. Sarah Sanders said that disenrollment and its outcomes could be one topic that could lead to a special session on Medicaid later this year.