Doctors and other health care providers are still awaiting payment on services provided to more than 4,000 infants who have gaps in their Medicaid coverage or pending applications because of problems with the state's computerized enrollment system, Department of Human Services officials told legislators Monday.
Mary Franklin, who became director of the state department's County Operations Division last month, said she hopes to have the backlog cleared within two months.
"Having this many children waiting for coverage is unacceptable to us," Franklin said. "This is not the way we want to do business."
The troubled computer-enrollment system also was a factor in the Human Services Department's decision to seek federal approval to pay insurance companies more than $7 million in premiums for providing coverage to private-option enrollees after the enrollees became eligible or requested the coverage to be canceled.
The enrollment system wasn't able to handle such cancellations until last summer, according to a letter the department sent Thursday to the federal Centers for Medicare and Medicaid Services.
The Arkansas Democrat-Gazette reported in September that as of Aug. 2, as many as 31,400 Arkansans, including newborns and others, had been waiting more than 45 days -- the maximum time allowed under federal rules -- for word on whether their applications had been approved.
The Human Services Department hasn't released figures on the total backlog of Medicaid applications since then.
David Wroten, executive vice president of the Arkansas Medical Society, said some applications for newborn coverage have been pending for a year.
Most doctors have been providing services to the children, without billing the parents, while they wait for the applications to be approved, he said.
"A small number are just not providing the services," he said.
The Human Services Department's new computer enrollment system has been under construction since 2013, and the cost has more than doubled, to $200 million, officials said last year.
In December, Gov. Asa Hutchinson directed the department to stop most work on the project until it can hire a "systems integrator" that would take responsibility for completing the system, either using the same IBM software that the department has been using or with a new software platform.
The new system is needed to determine eligibility under rules that took effect Jan. 1, 2014, under the 2010 Patient Protection and Affordable Care Act.
Franklin said the department began using the system to enroll newborns in January 2015.
Under federal regulations, a child born to a woman who is on Medicaid is automatically eligible for coverage for a year after the birth as long as the child lives with the mother and she remains eligible.
But because the enrollment system lacked a way to properly handle applications for the newly eligible infants, the department has had to manually process many applications, resulting in delays.
Franklin said recent improvements in the system have allowed the department to process the applications more quickly.
Meanwhile, she said, the department has assigned staff members to focus solely on processing the pending applications.
The department's letter to the federal Centers for Medicare and Medicaid Services seeking permission to repay insurance companies $7,023,123 in premiums also stems from problems with the new enrollment system.
The department recouped the premiums from insurers after retroactively terminating coverage for 4,317 private-option enrollees.
Because of a lack of functionality with the enrollment system, coverage for those enrollees wasn't terminated until months after they became ineligible or had asked to cancel their policies, Human Services Director John Selig told lawmakers.
Arkansas Blue Cross and Blue Shield notified doctors, hospitals and other providers on Thursday that it plans to begin recouping about $4.1 million in payments it made on behalf of enrollees whose coverage was retroactively canceled.
Those providers, in turn could seek reimbursement from the patients.
St. Louis-based Centene Corp. plans to recoup more than $1.1 million it paid providers, John Ryan, chief executive of the company's subsidiary, Celtic Insurance Co., said.
In the letter to the federal Medicaid agency, Human Services Department officials said they hope to prevent such recoupments by paying back the premiums they had previously recouped.
Selig told legislators that the department has since changed its interpretation of federal rules to avoid such recoupments. The department now considers a change in eligibility status to take effect on the day the change is processed, rather than on the day the department received the information about the change.
The premiums the department seeks to pay back to insurers make up a small part of the $1.5 billion in premiums the department has paid under the private option since it began in 2014, Selig told lawmakers.
Sen. Missy Irvin, R-Mountain View, whose husband is a physician, said the providers "acted in good faith" and shouldn't have to suffer because of the department's mistake.
"The only people that have not acted in good faith is this government, and that's completely unacceptable to me," she said.
The federal government is paying the full cost of the program through next year, when Arkansas is expected to begin paying 5 percent of the cost.
Under the private option, the department buys coverage on the state's insurance exchange for about 200,000 low income Arkansas.
The state created the program in 2013 as a primary way of extending coverage to adults with incomes of up to 138 percent of the poverty level: $16,243 for an individual, for instance, or $33,465 for a family of four.
A Section on 02/02/2016