After an eight-month delay, the Arkansas Department of Human Services plans to start Monday rechecking the eligibility of tens of thousands of Medicaid recipients, including those enrolled in the private option.
Federal regulations require the eligibility checks to be conducted annually. Although private-option sign-ups first began in October 2013, the department has conducted an annual check on only about 15,000 enrollees, Human Services Department Director John Selig said Thursday.
The eligibility checks have been delayed by difficulties in replacing the department's 25-year-old computerized eligibility and enrollment system for the Medicaid and food-stamp programs.
As of April 30, 250,799 Arkansans had been approved for coverage under the state's expanded Medicaid program, including 209,998 who had completed enrollment in the private option.
Starting Monday, the department will begin reviewing the eligibility of about 3,000 enrollees per evening using wage information from state Department of Workforce Services records, Human Services Department spokesman Amy Webb said Friday.
Those who appear to be ineligible will be sent notices directing them to provide proof of their eligibility within 10 days. If no proof is provided, the enrollees' coverage will be terminated.
The department will direct those whose coverage is terminated to healthcare.gov, where they can apply for federal tax-credit subsidies to help them buy coverage on Arkansas' federally run health insurance exchange, Webb said.
The records used for the eligibility verification won't indicate when the enrollee became ineligible for coverage, and the department will not seek to recover money from those who continued to receive coverage after they were no longer eligible, Selig said.
"As it is, we don't have the ability to go backwards" to verify what an enrollee's income was in the past, Selig said.
In preparation for the checks, the department planned to take its application website, access.arkansas.gov, offline starting at 9 p.m. Friday.
The website will remain down until 7 a.m. Monday, Webb said. After that, the hours when applications can be filed on the website will be reduced from 7 a.m.-11 p.m. to 7 a.m.-9 p.m. "to accommodate additional system work," she said.
The delays in replacing the department's outdated computer system resulted in the firing of one vendor, the withholding of funds from another and the doubling of costs.
In January, the Human Services Department fired Calverton, Md.-based EngagePoint, its lead vendor on the project, and replaced it with Princeton, N.J.-based eSystems.
The department is also withholding $1.2 million from Armonk, N.Y.-based IBM, citing a lack of functionality in the company's software.
Selig told legislators last month that the projected cost of the project has doubled, to about $200 million.
Under a $400,000 contract, the state Department of Information Systems has hired Gartner Inc. of Stamford, Conn., to evaluate the project, including whether the Human Services Department should continue implementing it with the IBM software.
"We want to work with whatever product in the long term is the best product for us," Selig told members of the Health Reform Legislative Task Force on Thursday.
The U.S. Department of Health and Human Services' Centers for Medicaid and Medicare Services has given the state until September to complete the checks, Webb said.
Authorized under the federal Patient Protection and Affordable Care Act and approved by the Arkansas Legislature in 2013, the expansion of the state's Medicaid program extended eligibility to adults with incomes of up to 138 percent of the federal poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.
Most of the newly eligible adults are covered under the private option, which uses Medicaid funds to buy commercial insurance on the state's health insurance exchange. Those whose health needs are considered exceptional are covered under the traditional Medicaid program.
The tax-credit subsidies are available to those who don't qualify for Medicaid and who have incomes of less than 400 percent of the poverty level: for example, $45,960 for an individual or $94,200 for a family of four.
The delays in implementing the Medicaid eligibility verification and enrollment system have not affected the department's ability to check the eligibility of about 175,000 Medicaid recipients whose eligibility was not affected by rules that went into effect under the Affordable Care Act on Jan. 1, 2014, Selig said.
Including those on the private option, almost 900,000 people were enrolled in Medicaid-funded coverage as of Sept. 30.
A Section on 06/13/2015