A public health expert said Arkansas is a "cause for concern" as federal protections of citizens on Medicaid and the Children's Health Insurance Program (CHIP) put in place at the start of the covid-19 pandemic are set to expire starting April 1.
The comments were made by Joan Alker, executive director of Georgetown University's Center for Children and Families, which released a report Wednesday estimating as many as 6.7 million American children are at risk of losing insurance coverage as Medicaid users are reevaluated.
The expected end of the federal public health emergency this spring means Arkansas will no longer receive enhanced federal matching rates in certain Medicaid programs and would have to cover an increased share of the cost for the programs.
The emergency's end also means the state will no longer have to abide by federal limitations that allow states to end Medicaid eligibility only for beneficiaries who die, go to jail or prison or ask to be removed from the programs.
Due to ACT 780, which the Arkansas legislature passed in 2021, the state has six months to re-assess Medicaid/CHIP eligibility, which is known as "Medicaid unwinding." That process began in February as the Department of Human Services began sending out notification letters.
"That's not good news for children and families," said Alker. "Because states have longer, they have 12 months and really 14 months when you count in the time that it takes to do a renewal. So states that rush are going to see more errors. Particularly if they're short staffed, which virtually all states are, and I believe Arkansas is.
"That's really, I think, the big concern in Arkansas, is moving so quickly. ... That's going to, I believe at the end of the day, cause more children to be uninsured, even if they're still eligible."
According to the state Department of Human Services, as of the end of December, the Division of County Operations within DHS had just over 845 eligibility caseworkers processing applications, renewals and changes.
"DHS wants everyone who remains eligible for and who needs Medicaid to retain their coverage, while also working to protect taxpayer dollars," Gavin Lesnick, a department spokesperson, said in an email. "We have been working over the last year to let Medicaid recipients know of the need to update their contact information and are now focused on letting recipients know to watch for renewal packets in the mail and [to] return the required information.
"Efforts include making outbound calls to recipients, meetings with numerous provider, partner and stakeholder groups across the state, awareness campaigns that point recipients and partners to online toolkits with additional information, paid advertising and more."
According to the Georgetown study, from February 2020 to August 2022 Arkansas added 65,772 children to Medicaid/CHIP, a 17.7% increase for a total of 436,612.
That represents 58.8% of the state's child population of 743,000 in 2021.
Overall, 1,019,232 Arkansans were enrolled in Medicaid/CHIP in August 2022.
According to the Georgetown study, millions of Americans are expected to lose coverage for two reasons: their income has risen, and they are no longer eligible or red tape barriers and poor communication and support from the state prevents families from renewing coverage, even though they are still eligible.
Loretta Alexander, the policy director of Arkansas Advocates for Children and Families, said she is "not as concerned as I was two months ago" about Arkansans being removed from Medicaid.
"Arkansas has assured us that they will only look at the folks that are in the category they call 'extended coverage', those folks that would not otherwise be eligible, were it not for that law (established in 2020) that didn't allow them to dismiss anybody," Alexander said.
Alexander said this applies to roughly 400,000 Arkansans.
"So actually, [Department of Human Services] is buying themselves some extra time by starting this process in February and not waiting until April 1 to start it," Alexander said. "So I'm not so concerned, because they're not doing all 1 million people in six months, they're just doing a portion of the caseload."
One major concern when it comes to the eligibility assessment is the ability for states to contact citizens about the eligibility, which is done via letters.
"One of the points we're making in this report is certainly there's been income fluctuation over this period of time," Alker said. "But because [a] child's eligibility level is so much higher than it is for parents, it's actually more common to find that a parent is no longer eligible for Medicaid, but the child still is. And that speaks to some of the complexity that we're dealing with here. Because when a parent receives a message that they aren't eligible anymore, they often assume that their child is no longer eligible either."
But the parent first needs to receive the letter.
The economic fluctuations of the last three years have created scenarios where it will be harder for states to get in touch with some citizens regarding their eligibility.
"We've had a lot of residential instability. We've had a lot of movement. People had to move for childcare reasons [and] for employment reasons," Alker said. "So we would expect that when the state is trying to contact families when sending them letters, some of those letters are never going to get to the parent. So that's problem [number one]."
Upon receiving the letter, a DHS spokesperson said all the details about how and when to send the packet back in will be included in that letter. DHS may have enough information to renew some recipients without the need for the beneficiary to submit additional information.
Alexander detailed her organization's efforts to inform Arkansans about the renewal period and eligibility concerns, which has included creating and sending out flyers to "stakeholders" and hosting forums with different health care organizations to make sure they are aware of the changes.
"Particularly in the case of people that might present to a doctor's office and they don't notice they're ineligible until they get to the doctor's office," Alexander said. "The main thing is making sure that their contact information is correct, more than anything else.
"Because let's face it, if they can't find you, they can't find you. But if they find you and you're still eligible, you won't lose your benefits."