Nearly 69,000 Arkansans lost Medicaid coverage in May because they either didn't return information needed to determine their eligibility or were no longer eligible, the state Department of Human Services reported Thursday.
The Arkansans include 43,385 whose coverage had been extended previously because of special eligibility rules during the federal covid-19 public health emergency and 25,453 others whose coverage was discontinued as part of normal operations, according to the department.
The figures reflect the second month of Medicaid eligibility redeterminations following the end of the continuous coverage requirement that was in effect during the public health emergency.
The redeterminations are part of a six-month campaign to unwind the state's Medicaid rolls that runs through the end of September.
In contrast, between 20,000 and 30,000 ineligible Medicaid beneficiaries were disenrolled each month during 2018 and 2019, prior to the covid-19 pandemic, state Department of Human Services spokesman Gavin Lesnick said.
Besides those who were disenrolled in May, 39,848 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules, the department said.
As of June 1, the state's Medicaid enrollment totaled 1,020,020, compared to 1,066,541 as of May 1, according to Lesnick.
The state's Medicaid enrollment totaled 1.13 million on April 30.
The continuous coverage requirement meant that no Arkansans could be removed from the Medicaid rolls for a change in income or eligibility until the federal public health emergency ended, and cases could be closed only if individuals moved out of state, died, were incarcerated or requested their coverage end.
According to the Human Services Department, Arkansas' Medicaid rolls increased by more than 230,000 during the pandemic.
"We will continue in subsequent months to swiftly disenroll individuals who are no longer eligible, as this ensures that Medicaid resources go to beneficiaries who truly need them," the department said Thursday in its news release announcing the latest figures.
"We also will continue to provide information to those who no longer qualify for Medicaid on how they can maintain health care coverage, such as through an employer plan or the federal health insurance marketplace," the department said.
"Beneficiaries who need assistance can submit questions through ar.gov/accessanywhere, call 855-372-1084, or visit ar.gov/renew for additional information."
The department said the disenrollments announced Thursday follow more than a year of outreach, leading up to the end of the public health emergency, during which the department made calls to recipients, met with numerous providers, partners, and stakeholder groups, conducted awareness campaigns about the need to update addresses and watch for renewal letters, engaged in paid advertising, and more.
According to the department, special emphasis was placed on reaching families with children covered by Medicaid, including: providing lists of patients at risk of being disenrolled to pediatricians; sending materials to be distributed to families through school districts, school nurses, agency partners, and libraries; calling families directly; and partnering with community-based organizations across the state, including many that directly serve children and families.
According to the department, the Medicaid beneficiaries who were disenrolled in May included 31,754 who failed to return the renewal form, 9,900 who failed to return requested information and 6,412 who requested their coverage be discontinued.
In addition, the department reported that 8,287 Medicaid beneficiaries had a household income above the limit for their household size, and 3,093 could not be located.
The department reported that 29,415 of the 68,838 Medicaid beneficiaries who were disenrolled in May were in the state's Medicaid expansion program called ARHOME, 20,512 were in the ARKids A program and 10,813 were in the parent or caretaker relative program.
ARHOME stands for Arkansas Health and Opportunity for Me. The program was first authorized by the Republican-controlled Legislature and then-Democratic Gov. Mike Beebe in 2013 and has operated under a waiver granted under the federal Affordable Care Act.
In addition, the department said 3,789 Medicaid beneficiaries disenrolled in May were newborns, and 1,329 were in the ARKids B program.
Loretta Alexander, Arkansas Advocates for Children and Families' health policy director, said in a statement Thursday that her "first reaction is continued alarm at the number of children losing coverage (over 25,000).
"And about 2/3 of all the cases were closed for procedural reasons," she said.
The Human Services Department said in its news release that "a closure because of a procedural reason does not mean that the packet was not received or that the beneficiary was unaware of this process.
"In fact, extensive efforts have been made – and are continuing to be made – to ensure that Medicaid recipients know what to expect," the department said.
Among cases due in each month, procedural closures declined by more than 37 percent in May from April, according to the department.
The department said wherever possible, eligible beneficiaries have their coverage renewed through an automated process that involves passively checking data against existing sources rather than requiring new information be submitted.
These renewals, called ex parte, eliminate the need for beneficiaries to respond at all if they are confirmed to still be eligible, according to the department. In May, more than 29,000 beneficiaries had their coverage renewed using ex parte reviews, the department said.
In the federal Families First Coronavirus Response Act of March 2020, states were provided an increase of 6.2 percentage points in federal matching funds in certain Medicaid programs if they agreed to provide continuous eligibility through the federal public health emergency, according to the department.
The rate enhancement dropped to 5 percentage points starting April 1 and will be phased out gradually by the end of this year. For example, the federal government is covering 76.31%, including the 5-percentage-point rate enhancement, of the cost of the traditional Medicaid program, with Arkansas covering the other 23.69%, through June 30.
In December, the federal Consolidated Appropriations Act of 2023 granted states the authority to begin the process of redetermining the eligibility of Medicaid beneficiaries kept on the Medicaid rolls because of the continuous coverage requirement, starting April 1, and to reinstate routine eligibility operations, according to the Human Services Department.
Within 180 days of the expiration of restrictions on the department's ability to disenroll individuals, such as those imposed by the federal Families First Coronavirus Response Act, Arkansas Act 780 of 2021 requires the department to complete and act on eligibility reevaluations for all cases that have not had a reevaluation within the past 12 months.
Act 780 of 2021 was sponsored by state Sen. Scott Flippo, R-Mountain Home, who has said he expects "tens of thousands" of Medicaid beneficiaries to be removed from the Medicaid rolls because they don't meet eligibility requirements.
In April, Human Services Department Chief of Staff Mark White told lawmakers that department officials didn't know whether 50,000, 150,000 or 200,000 Arkansans will lose Medicaid coverage over this six-month period with Arkansas and other states returning to normal eligibility rules.
A month ago, the department reported that 72,802 Arkansans were disenrolled from Medicaid at the end of April because they either didn't return information needed to determine their eligibility or were no longer eligible. Among all cases due in April, 61,236 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules.
The department has described unwinding the continuous enrollment condition as one of the largest and most complex efforts for state Medicaid programs since the implementation of the Affordable Care Act.