Enrollment in Arkansas' Medicaid expansion program, known as Arkansas Works, fell by about 2,900 people in November to just under 307,000, the state Department of Human Services reported Tuesday.
In a meeting with reporters, Human Services Department officials also outlined eligibility verification efforts they said have resulted in the removal of about 73,000 people from the program since the beginning of 2017.
Those measures include terminating coverage when mail sent to an enrollee's address is returned, identifying enrollees who are receiving public benefits in more than one state and rechecking the incomes of enrollees when they start new jobs.
Another 7,198 Arkansas Works enrollees are set to lose coverage Jan. 1 after the Human Services Department received information indicating they are eligible for Medicare, the federal insurance program for the elderly and disabled.
In a news release, Gov. Asa Hutchinson called the efforts "a model for containing costs and eliminating waste in state government."
Human Services Department Director Cindy Gillespie "and her team combined common-sense fact-finding with new technology to reduce our load by 80,000 cases," Hutchinson said. "DHS is among state agencies that are leading by example, and I applaud the smart approach."
Hutchinson has requested federal approval to move an additional 60,000 enrollees off the program by limiting eligibility to adults with incomes of up to the poverty level, instead of 138 percent of the poverty level.
He has also asked to impose a work requirement on some of those remaining on the program. Federal officials had not ruled on the request as of Tuesday.
In a statement published Tuesday, the Center for Budget and Policy Priorities, a research organization in Washington, D.C., focused on reducing poverty and inequality, said limiting eligibility to the poverty level, which Massachusetts has also proposed, wouldn't support the purpose of the Medicaid program as the law governing Medicaid waivers requires.
"These waiver proposals neither identify any policy that the state would be testing by rolling back coverage for current beneficiaries nor explain how rolling back coverage furthers Medicaid's objectives," Jessica Shubel, a senior analyst with the center, wrote.
"Moreover, the one rationale that's included in both proposals -- saving money for the states -- is not a permissible use of" authority under Section 1115 of the Social Security Act, which sets requirements for waivers.
Hutchinson spokesman J.R. Davis said restricting eligibility for Arkansas Works would allow the state to "focus our limited resources on those who need it most."
He noted that those who are moved off Arkansas Works would be eligible for subsidized coverage offered through healthcare.gov under the 2010 Patient Protection and Affordable Care Act.
"At that point, it's on them whether they to choose to do that or not, but the access is not going away," Davis said.
Before it was expanded in 2014, the state's Medicaid program covered primarily poor people who are elderly or disabled, children from low-income families and parents with incomes of up to 17 percent of the poverty level.
The 306,849 people enrolled as of Nov. 30 included 283,784 who were assigned to coverage in private plans, with the Medicaid program paying most or all of the premiums, under the so-called private option.
The other 23,065 people were being covered by the traditional, fee-for-service Medicaid program because they were considered "medically frail," with health needs that private plans don't typically cover.
Gillespie said the department increased its efforts to remove ineligible people from the program this year after focusing last year on clearing out a backlog of applications and other overdue paperwork.
As a result, enrollment has fallen since late January, when more than 330,000 people were covered.
Those who have been removed include 26,093 who were sent letters that were returned because the enrollee no longer lived at the address on file with the department.
An additional 25,742 were removed after information from a federal database indicated they had received benefits in another state.
Because of problems the department encountered installing a new enrollment and eligibility verification system, officials weren't able to check the database for information on Arkansas Works enrollees until this year.
Early this year, the department also began checking the state Department of Workforce Services' records on employees that employers reported as being newly hired, Mary Franklin, director of the Human Services Department's Division of County Operations, said.
When Arkansas Works enrollees are reported having been recently hired, the Human Services Department checks the pay at the new job to see if the enrollee is still eligible for assistance. Those reviews have resulted in 16,467 enrollees being removed from the program, Franklin said.
An additional 4,131 enrollees were removed after the Human Services Department learned they were being held in state prisons, Franklin said.
The department had already checked the state Department of Correction's inmate rosters to identify Medicaid recipients who were incarcerated, but began receiving more detailed information after the state's Office of Medicaid Inspector General found some inmates who were still on Arkansas Works, she said.
The department also removed 762 people from Arkansas Works after insurance companies reported that those enrollees were also enrolled in separate plans offered through healthcare.gov and subsidized by federal tax credits.
Similarly, the department began receiving information about Medicare eligibility more quickly after it began using a new computer system on Nov. 1, resulting in the 7,198 enrollees who will lose Arkansas Works coverage Jan. 1.
Previously, the department received information on Medicare eligibility when an enrollee turns 65 or during an annual check of the enrollees' Medicaid eligibility, Franklin said.
Ensuring that only those who are eligible are enrolled is especially important for Arkansas Works, Gillespie said, because the state makes monthly premium payments on behalf of each private option enrollee even if that enrollee doesn't have any medical expenses.
The monthly cost per enrollee in November was $519.89, the Human Services Department reported Monday. That included an average payment to insurance companies of $515.59 and an average expense of $4.31 per enrollee for benefits, such as nonemergency medical transportation, that private plans don't cover.
Although the federal government is paying for most of the costs associated with Arkansas Works, the state will owe money to the federal government if the cost of the private option from 2017-2021 exceeds a limit that will be calculated based on monthly caps, which increase each year.
The cap this year is $570.50. Through November, the program's monthly per enrollee cost averaged $511.82.
A Section on 12/20/2017