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After a hiatus of more than two months, the Arkansas Department of Human Services has resumed its review of the eligibility of hundreds of thousands of Arkansans who have been enrolled in the private option or traditional Medicaid for at least a year.

Human Services Department spokesman Kate Luck said Tuesday that the department used electronic records Monday evening to verify the eligibility of 3,334 recipients.

Twenty-two recipients were found to be ineligible.

Luck said she did not have information on whether the department plans to send notices requesting additional information from any recipients whose eligibility could not be determined from the records.

From mid-May through Aug. 21, the department used its new computerized enrollment and eligibility verification system to begin eligibility reviews of 395,331 recipients, Luck said.

Coverage has been renewed for 80,965 recipients and terminated for 60,952.

Of those whose coverage was terminated, 16,354 had their coverage restored after they provided proof of their eligibility.

Originally scheduled to begin last fall, the eligibility review was delayed until mid-May because of difficulties the Human Services Department encountered in installing the new system.

The department then halted the review in late August after the federal Centers of Medicare and Medicaid Services changed its advice regarding the department's practice of giving Medicaid recipients 10 days to respond to requests for income-related records.

At the federal agency's direction, the Human Services Department revised its notices to give recipients 30 days to respond to such income requests.

The eligibility reviews didn't start up again until Monday.

The department also is being allowed to verify eligibility using information from the food stamp and welfare programs after the Centers for Medicare and Medicaid Services granted the state a waiver to do so.

The waiver allows Arkansas to enroll or renew coverage for Arkansans who report their income as being low enough to qualify for Medicaid when food stamp and welfare program records indicate they are "highly likely to be income-eligible for Medicaid," according to a letter from the federal agency to the state received Friday.

The enrollees must also meet age, residency and citizenship requirements.

"The CMS has determined that the authorities granted in this letter are necessary to protect beneficiaries in light of delays in the development and deployment of critical renewal functionalities in Arkansas' eligibility and enrollment system," which have resulted in "a backlog of Medicaid applications and renewals," wrote Anne Marie Costello, acting director of the federal agency's Children and Adults Health Programs Group.

Arkansas has permission to use the food stamp and welfare records "only to the extent to which Arkansas requires additional time to build and test critical enrollment and renewal functionality in its systems, and are contingent upon regular updates from the state on the status of its systems development and capacity," the letter says.

Mark White, a Human Service Department deputy director, told the state Health Reform Legislative Task Force on Tuesday that the department also will no longer request additional information from recipients who reported having no income in their initial applications and are found during the annual review to have no income listed in state wage records.

Previously, the department had required recipients to submit statements declaring that they have no income.

Federal rules that went into effect Jan. 1, 2014, required the state to install the new eligibility and enrollment system to verify income, Human Services Department officials have said.

The rules affect about 600,000 Medicaid recipients, including private-option enrollees and children covered by ARKids First.

Because of delays in implementing the system, the Centers for Medicare and Medicaid Services has granted Arkansas extensions on conducting eligibility reviews that have been due since Jan. 1, 2014.

The latest extension, granted Sept. 30, gives the state until Dec. 31 to complete the reviews.

The eligibility of about 200,000 other Medicaid recipients, including nursing home residents, was not affected by the new rules, department officials have said. The department's old eligibility and enrollment system is still being used to review the eligibility of those recipients.

Also on Tuesday, representatives of the three insurance companies offering private-option plans told the task force about their efforts to curb enrollees' unnecessary emergency room visits.

Stephen Sorsby, vice president of medical affairs with Little Rock-based QualChoice Health Insurance, said one enrollee visited the emergency room 58 times over the past year.

Such visits are often difficult to prevent, Sorsby said.

If a customer comes to an emergency room complaining of chest pain, "we're going to cover this ER visit even if we believe that that member is primarily in the ER because he needs two hots and a cot," Sorsby said.

He said the company attempts to refer such customers to programs that can help with housing and other needs.

Created by the Legislature in 2013, the private option pays for coverage on the state's health insurance exchange for more than 180,000 low-income Arkansans who became eligible for assistance under the expansion of the state's Medicaid program.

At Gov. Asa Hutchinson's request, the Legislature earlier this year created the task force to recommend a program that will replace the private option in 2017, when the federal waiver authorizing it expires and Arkansas will begin paying a portion of the program's cost.

The state's share will start at 5 percent and rise each year until it reaches 10 percent in 2020. Currently the federal government pays the full cost of the program.

The task force is expected to issue its recommendations next month.

A Section on 11/11/2015

Print Headline: State Medicaid reviews restart

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