Enrollment in Arkansas' Medicaid expansion program, known as Arkansas Works, fell by 3,600 people from March 1 to April 1, the state Department of Human Services reported.
The department also reported that the monthly per-person cost for people in the program with subsidized private coverage fell in March by almost $17, to $566.57.
At the first of this month, 281,033 people were covered under Arkansas Works, down from 284,670 on March 1 and 285,564 on Jan. 1, according to the Human Services Department.
Meanwhile, enrollment in the traditional Medicaid program grew by 436 people, to 653,714 from March 1 to April 1.
Arkansas Works covers people who became eligible for Medicaid when the state extended eligibility in 2014 to adults with incomes of up to 138 percent of the poverty level.
This year, for instance, that annual income cutoff is $16,753 for an individual or $34,638 for a family of four.
The traditional Medicaid program primarily covers low-income children and poor people who are elderly or disabled.
Under the so-called private option, most Arkansas Works enrollees are covered by private plans offered on the state's health insurance exchange. The Medicaid program pays most or all of the premium and provides additional subsidies that reduce or eliminate the enrollee's out-of-pocket costs for medical care.
Enrollees who are considered medically frail, with health needs that private plans don't typically cover, are assigned to the traditional Medicaid program, which pays for care directly, but they are included in the Arkansas Works enrollment numbers.
A federal waiver authorizing the private, subsidized coverage under Arkansas Works limits the per-enrollee cost of that coverage using monthly per-person caps, which increase every year by 4.7 percent.
Last year and so far this year, the cost of the program has been below the cap, which this year is $597.32 per enrollee, per month.
Premiums for the private plans vary based on the enrollee's age, county of residence, choice of health plan and whether the enrollee is a smoker.
If the cost of the private coverage from 2017-2021 exceeds a limit that will be calculated using the monthly per-enrollee cost caps, the state will owe the difference to the federal government.
Human Services Department spokesman Marci Manley said in an email Wednesday that the per-enrollee cost fluctuates from month to month, "so we don't have a specific reason for this month's change."
As long as the cost of Arkansas Works stays below the cap, the federal government is expected to pay 94 percent of the cost this year, with the state paying the rest.
Under the 2010 Patient Protection and Affordable Care Act, Arkansas' share will rise to 7 percent next year and 10 percent for 2020 and future years.
Gov. Asa Hutchinson has credited the state's economy and efforts to verify eligibility with reducing Arkansas Works enrollment by almost 59,000 people from Jan. 1, 2017, to the beginning of this year.
Since Jan. 1, enrollment has fallen an additional 4,531 people.
The state is also preparing to impose a work requirement on some enrollees. The requirement will apply to enrollees age 30-49 this year, starting June 1, and younger enrollees starting next year.
Hutchinson has also requested federal approval to move tens of thousands of people off the program by reducing eligibility to the poverty level.
Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, said last month that federal officials are "continuing to work through the issues regarding that" request.
The drop in Arkansas Works enrollment so far this year has been more than offset by increased enrollment in traditional Medicaid.
From Jan. 1 to April 1, enrollment in traditional Medicaid, not including the medically frail Arkansas Works enrollees, grew by 8,272 people, to 653,714.
As a result of the traditional Medicaid growth, overall Medicaid enrollment increased from 931,006 on Jan. 1 to 934,747 on April 1. Arkansas' population is roughly 3 million.
Arkansas pays about 30 percent of the cost of coverage for the traditional Medicaid program, with the federal government paying the rest.
Manley said Human Services Department officials have "no analysis ongoing, nor is any analysis planned" on the reasons for the changes Medicaid enrollment since January.
Metro on 04/19/2018