Federal official urges Arkansas, other states not to rush Medicaid eligibility reviews

Care urged on eligibility checks

Daniel Tsai, director of the Center for Medicaid and CHIP Services at the U.S. Centers for Medicare and Medicaid Services, answers questions via video in this screenshot from an event recorded Dec. 3, 2021. Tsai spoke to Arkansas reporters via videoconference on Friday, June 9, 2023 about states redetermining who is and isn't eligible for Medicaid after the end of the federal covid-19 public health emergency, saying that federal officials have significant concerns about the percentage of people losing Medicaid coverage in Arkansas and other states as a result of what he called "procedural reasons and nonresponse." (Image courtesy Health Affairs, YouTube)

Federal officials have significant concerns about the large percentage of people losing Medicaid coverage in Arkansas and other states as a result of "procedural reasons and nonresponse" as the states resume efforts to check beneficiaries' eligibility, a federal Medicaid official said Friday.

An Arkansas Department of Human Services spokesman countered that extensive efforts have been made and are continuing to be made to ensure the beneficiaries know what to expect.

Daniel Tsai, director of the Center for Medicaid and CHIP Services at the U.S. Centers for Medicare and Medicaid Services, spoke via videoconference with a handful of reporters in Arkansas about the eligibility redetermination process that started with the end of the federal covid-19 public health emergency.

Federal Medicaid officials "appreciate that Arkansas state staff have tried a range of things, and we are aware of -- to give credit where credit is due -- all sort of new forms of outreach and ways of updating contact information and things of that sort," Tsai said.

But he said, "No. 1, we have been clear since Day One we think people should not rush the process.

"States should not rush the process and should do their best to spread out work over 12 months, and I know there is quite a push in Arkansas to do things quickly," Tsai said. "I know there may be legislative pieces, but for human beings who are going through this process, who are going to get stuck in the bureaucracy and red tape, pushing through things and rushing it will lead to eligible people and kids and families losing coverage for some period of the time."

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 DHS to complete and act on eligibility reevaluations for all cases that have not had a reevaluation within the past 12 months.

Act 780 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.

May is the second month of Medicaid eligibility redetermination in Arkansas after 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 in Arkansas to unwind the state's Medicaid rolls that runs through the end of September.

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. Cases could be closed only if individuals moved out of state, died, were incarcerated or requested their coverage end. According to DHS, Arkansas' Medicaid rolls increased by more than 230,000 during the pandemic.

In May, 43,385 of the 68,838 Arkansans who lost Medicaid coverage had their coverage extended previously because of special eligibility rules during the federal public health emergency, according to DHS.

Of those 43,385 Arkansans, 24,891 failed to return a renewal form, 5,354 had household income above the limit for their household size, 3,307 asked to be disenrolled, 2,926 failed to return requested information and 1,721 could not be located, the department reported Thursday.

Among all cases due in May, 39,848 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules.

In April, 44,667 of the 72,802 Arkansans who lost coverage had their coverage extended previously because of the special eligibility rules during the federal public health emergency, the department reported a month ago.

Of those 44,667 Arkansans, 35,625 failed to return a renewal form, 2,685 asked to be disenrolled, 1,596 failed to return requested information, 1,485 had household income that's above the limit for their household size and 739 could not be located, the department reported. Among all cases due in April, 61,236 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under the normal eligibility rules.

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, according to the department.

DHS spokesman Gavin Lesnick said Friday that it's important to note that a closure because of a procedural reason does not mean that a renewal packet was not received or that the beneficiary was unaware of the process.

"While some of these individuals will return their renewal packet and confirm that they no longer qualify, it is likely that many others simply will not return their packet because they are aware that their case will close given their change in circumstances," he said in a statement.

Lesnick said DHS is required under state law to finish the redeterminations of extended clients within six months of the end of the continuous coverage requirement.

"DHS has been working for more than a year on outreach to prepare beneficiaries for the redetermination process, and we will maintain this focus in the coming months," he said. "We are fully compliant with federal requirements and will work closely with CMS going forward to ensure that the unwinding progresses as effectively and efficiently as possible."

Beyond recommending Arkansas not rush the Medicaid redeterminations, Tsai said federal officials appreciate that Arkansas officials are trying to figure out how to increase the auto renewal rate for Medicaid beneficiaries. He said that there are other waivers and strategies that could help increase that, and he hoped all states, including Arkansas, will take up all of those strategies.

He also said that "the way notices are structured and other pieces are sometimes confusing and hard to access for people.

"We want states and every state to really make the process as simple and consumer-friendly as possible, so people really have a chance to respond effectively to their renewal process," he said.

Lesnick said DHS has an active and productive dialogue with the Centers for Medicare and Medicaid Services, and "we look forward to continuing this partnership as we redetermine eligibility for Medicaid recipients following President Biden's ending of the Public Health Emergency."

DHS and the Centers for Medicare and Medicaid Services "have a shared focus on ensuring that eligible Medicaid beneficiaries keep coverage, and that those who are no longer eligible are disenrolled," he said.

"The state has implemented a number of strategies to help keep eligible people covered, including using verified data DHS already has to conduct renewals and accepting addresses from the postal system and managed care organizations," Lesnick said.

Arkansas Advocates for Children and Families said Friday in a blog post that "more than 54,000 Arkansas children have lost their health insurance in just two months -- an outcome of our state's unnecessarily speedy Medicaid eligibility redetermination process.

"That's an alarming 7% of the state's overall child population, which should be enough to make the state change course," the group said.

The group said the state is rushing the process because Arkansas legislators decided to force the state Medicaid program to complete the renewals in six months.

"Most state Medicaid programs are using the 12 months allowed by the federal government to avoid unnecessary terminations," the group said. "We should not be in such a hurry that we continue to deny eligible Arkansans necessary health coverage. This is not a race."

Lesnick said special emphasis has been placed throughout the process on reaching families with children covered by Medicaid to ensure that eligible children retain coverage.

"These efforts include 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 covered by ARKids directly, and partnering with community-based organizations across the state, including many that directly serve children and families," he said. "We are also now prioritizing calls to ARKids families who have not returned their packet, engaging new paid advertising, asking partners to send new messages to clients, and sending emails to families whose cases are scheduled to close because information has not been returned."

Tsai said federal Medicaid officials are noticing that many children across the nation are losing health insurance coverage through Medicaid, and one of the reasons is that their parents are no longer eligible for Medicaid due to their higher income or job situation.

But he said the children of these adults are still eligible for Medicaid in many of these cases, and federal officials are trying to urge parents to return the Medicaid renewal form.

Lesnick said ARKids First-B is for people who do not qualify for regular Medicaid, but still do not have health insurance for their children. A child could also be eligible for a different Medicaid program based on a disability or condition, he said.

Nicholas Horton, founder and chief executive officer of the Opportunity Arkansas group, said DHS' report on Thursday "is welcome news for Arkansas taxpayers and the truly needy who rely on the safety net.

"Our Medicaid program has largely been on auto-pilot for the last several years, due in large part to the perpetuation of eligibility restrictions by the Biden administration," Horton said in a statement. "... Arkansans support these efforts to clean up the rolls and return to normal. Keep in mind: most of these enrollees are receiving pre-populated forms. All they have to do is sign and return it in many, many cases. Less than 4 percent of the extended enrollees were removed because they couldn't be located.

"We are leading the nation in restoring integrity to our Medicaid system," Horton said, and Arkansans should be grateful for the leadership of Gov. Sarah Huckabee Sanders, DHS Secretary Kristi Putnam and state Medicaid Director Janet Mann, who have been leading the effort.

"Their strategy has been thoughtful yet efficient," he said.

As of June 1, the state's Medicaid enrollment totaled 1,020,020, compared with 1,066,541 as of May 1, according to Lesnick. The state's Medicaid enrollment totaled 1.13 million on April 30.

DHS officials have repeatedly said that they didn't know whether 50,000, 150,000 or 200,000 Arkansans would lose Medicaid coverage over the six-month period.