Medicaid ends for 17,000 despite reprieve for others

More than 17,000 individuals will lose their health coverage today despite a federally mandated change in Arkansas' process for conducting Medicaid renewals, a spokesman for the state Department of Health and Human Services said Monday.

The affected private-option enrollees and other Medicaid recipients failed to respond to requests for pay stubs or other income-related records within a 10-day deadline.

Under a change ordered by the U.S. Centers for Medicare and Medicaid Services, the state Human Services Department said Friday that it would begin giving recipients 30 days to provide such records.

But Human Services Department spokesman Amy Webb said Monday that the new policy does not apply to those whose coverage had already been scheduled to end today because they did not respond to the income-verification requests within the earlier 10-day deadline.

An article in Saturday's newspaper about the new policy incorrectly said the 30-day extension would grant a reprieve to those previously set for termination of benefits.

Webb said Monday that the Centers for Medicare and Medicaid Services did not ask the Human Services Department to apply the policy change retroactively to those who had received termination notices.

"There's no easy way in our system to do that because they're already slated for closure," she said.

Arkansas Advocates for Children and Families has called on the Human Services Department to reinstate coverage for Medicaid recipients whose coverage has already ended and to give additional time to those whose coverage is set to end.

"I think the federal regulations are clear in that everyone should be subject to the same 30-day window," said Marquita Little, director of health care policy for Arkansas Advocates for Children and Families.

Sen. David Sanders, R-Little Rock, and a sponsor of the law creating the private option, said he also would prefer recipients be given additional time before cutting off their coverage but that he understood that might be a difficult administrative task.

Kevin De Liban, an attorney with Legal Aid of Arkansas, said today's terminations are "completely out of step with the requirements of federal law."

"It's going to cause major disruptions and bureaucratic entanglements," he said.

Webb said the Human Services Department is granting additional response time to Medicaid recipients and private-option enrollees who have received requests for income records but who have not yet received terminations.

New letters asking for the income information will tell recipients they have 30 days instead of 10 days to provide the information, she said.

Webb didn't know how many people will receive those notices.

Citing federal regulations, Judith Cash of the Centers for Medicare and Medicaid Services wrote in an email to Arkansas Medicaid Director Dawn Stehle on Thursday night that Arkansas should give recipients 30 days to respond to records requests.

Cash is director of the federal agency's Children and Adult Health Programs Group's Eligibility and Enrollment Division.

An agency spokesman didn't respond to requests for comment on Friday or Monday.

The coverage terminations are the result of a review of the incomes of Medicaid recipients who have been enrolled for at least a year.

When state wage records on a recipient are not available or indicate that a recipient's eligibility status has changed, the Human Services Department sends the recipients notices requesting pay stubs or other records, such as a letter stating that the recipient has no income.

In such cases, federal regulations require a state to send the recipient a "pre-populated renewal form" and to give the recipient at least 30 days to complete and return the form.

The department's enrollment and eligibility-verification system is unable to generate such forms, so the department has sent the recipients letters asking for proof of income, Webb said.

Human Services Department officials have maintained that the 30-day requirement does not apply to such requests for income records.

Since the income checks began in mid-May, 58,974 Medicaid recipients, including 39,355 private-option enrollees, have received notices informing them that their coverage will end.

Of those recipients, only 2,384 were found to be ineligible. The remaining 56,590 had failed to respond to the Human Services Department's income requests.

The coverage for 35,668 private-option enrollees and other Medicaid recipients ended on Aug. 1.

Coverage has been reinstated or was not terminated for 3,561 recipients who received termination notices but later provided records showing they were still eligible.

If such information is provided within 90 days of the termination, the coverage can be restored retroactively.

Originally expected to begin last fall, the state's income reviews were delayed by seven months because of difficulties the Human Services Department has encountered in building the enrollment and eligibility-verification system.

The new system is needed to conduct the income checks according to rules that went into effect on Jan. 1, 2014, under the 2010 federal Patient Protection and Affordable Care Act, Human Services Department officials have said.

The Human Services Department on Aug. 21 stopped conducting the income checks after Centers for Medicare and Medicaid Services department officials said they would be issuing "changed guidance" about Arkansas' process, Webb has said.

Webb said her department will resume the income reviews after it revises its notices to reflect the 30-day deadline.

Under the private option, the state uses Medicaid funds to pay the premiums and provide other subsidies for adults with incomes up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.

Of the private-option enrollees whose coverage is set to end today, 6,460 are covered by Arkansas Blue Cross and Blue Shield, and 2,387 are covered by St. Louis-based Centene Corp., Webb said.

Both companies have said they would continue covering prescription drugs for 30 days for customers whose private-option coverage ended July 31 or will end today for failure to provide income-related records to the Human Services Department.

The companies said they would treat medical claims during the 30-day extended coverage period as "pending."

If an enrollee's Medicaid eligibility is not reinstated within the 30-day window, the companies will pay for the drugs, but not for the medical services.

The companies won't receive monthly premiums for the extension for enrollees whose coverage is not reinstated.

Little Rock-based QualChoice Health Insurance, which covers 5,529 private-option enrollees whose coverage has ending, has not offered the extended coverage.

Michael Stock, the company's chief executive, said the company feared that auditors with Centers for Medicare and Medicaid Services might later question why the company paid claims for people who were not eligible for coverage.

The company has sent letters to customers whose coverage has been canceled encouraging them to submit proof of their eligibility to the Human Services Department.

Little said Medicaid recipients who receive requests for income records should submit copies in person to a Human Services Department office and ask for a written acknowledgment of the submission.

Recipients can also call the department to request additional time to provide the information, she said.

A Section on 09/01/2015