The cases of 72,802 Medicaid beneficiaries in Arkansas were closed at the end of April because they either didn't return requested information necessary to determine their eligibility or are no longer eligible for Medicaid, the Arkansas Department of Human Services reported Monday.
The closed cases include 44,667 Medicaid beneficiaries whose coverage had been extended previously because of the special eligibility rules during the federal public health emergency and 28,135 other Medicaid beneficiaries whose coverage was closed as part of normal operations, state Department of Human Services spokesman Gavin Lesnick said. The reasons for ending the Medicaid coverage varied among these groups, he said.
The figures reflect the first month of Medicaid eligibility re-determinations as part of the department's six-month campaign to unwind Arkansas' Medicaid rolls following the end of the continuous coverage requirement that was in effect during the federal government's public health emergency, the department said in a news release.
In contrast, about 25,000 Medicaid beneficiaries were dis-enrolled each month in 2018 and 2019 prior to the covid-19 pandemic, according to the department.
Among all cases due in April, 61,236 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed by the department under the normal eligibility rules, the department said.
A critic of the unwinding, Loretta Alexander, health policy director for the Arkansas Advocates for Children and Families, pointed out that more than 52,000 of the Medicaid beneficiaries whose cases were closed in April had paperwork issues.
The continuous coverage requirement during the federal public health emergency prevented the state Department of Human Services from removing most ineligible individuals from Medicaid, but normal eligibility rules resumed April 1, according to the department. The 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.
The state Department of Human Services "is moving swiftly to dis-enroll individuals who are no longer eligible to ensure that Medicaid resources go to beneficiaries who truly need them, and this will continue in the coming months as the unwinding progresses," the department said in its news release.
Lesnick said the Medicaid program's enrollment totaled 1.06 million May 1 -- which reflects the 72,802 case closures -- and Medicaid's enrollment totaled 1.13 million April 30.
According to the Department of Human Services, Arkansas' Medicaid rolls increased by more than 230,000 during the covid-19 pandemic. "We expect total enrollment to continue to decline as we reevaluate eligibility and we will report the numbers each month during the process," according to the news release.
The department said it has been working for more than a year to prepare for the end of the federal public health emergency. Among other things, the department's efforts have included making calls to recipients; meeting with numerous providers, partners and stakeholder groups across the state; conducting awareness campaigns that point recipients and partners to online tool kits with additional information; and paid advertising campaigns.
According to the department, 44,714 of the 72,802 Medicaid beneficiaries whose cases were closed in April failed to return the renewal form, 7,673 of them failed to return requested information, and 5,791 of them requested closure of the cases.
In addition, the department reported that 5,414 of these Medicaid beneficiaries, whose cases were closed in April, had household income above the limit for their household size, and 2,024 were unable to be located.
Alexander said the state Department of Human Services' figures "bear out our concern that thousands of eligible people would lose their Medicaid coverage during this process."
"This many people losing coverage without a true determination of being ineligible based on income is verification that this process needs to be slowed down," she said.
Alexander said 52,387 out of 72,802 Medicaid beneficiaries, or about 72%, lost coverage because of paperwork issues, citing the 44,714 who failed to return the renewal form and the 7,673 who failed to return requested information.
The department reported 28,223 of the 72,802 Medicaid beneficiaries whose cases were closed in April were in the state's Medicaid expansion program called ARHOME, 23,837 were in the ARKids A program, and 12,906 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 3,367 of the Medicaid beneficiaries whose cases were closed in April were newborns and 1,863 were in the ARKids B program.
"We don't want kids losing health care access unnecessarily," Alexander said, noting children included in ARKids A and ARKids B and newborns totaled 29,067 of the 72,802 cases closed in April.
"We know some folks will have lost coverage because they're making more money (minimum wage increase), but we want to make sure there's a smooth transition to marketplace coverage," she said in a written statement. "However, only a small percentage were over income, 5,414 out of 72,802."
Nicholas Horton, founder and chief executive officer of Opportunity Arkansas, said Monday in a written statement that "Despite the caterwauling from the Left and dependency defenders, these numbers from DHS are good news.
"It means fewer Arkansans dependent on Medicaid -- and ultimately it means fewer ineligible Arkansans dependent on Medicaid," he said. "Nearly 60 percent of those removed from the program were able-bodied, working-age adults. No doubt many of them failed to renew their coverage because they knew they didn't qualify -- or had already obtained other coverage through work or through the ObamaCare exchange."
Ultimately, Arkansans deserve a strong safety net that is protected for the truly needy, not a catch-all welfare system that is filled with fraud and abuse, Horton said.
"Every time an ineligible enrollee is removed from Medicaid, we are one step closer to restoring our safety net for those that truly need it," he said.
According to the state Department of Human Services, Medicaid beneficiaries who believe they have been dis-enrolled in error may appeal the determination. If individuals were dis-enrolled because they did not respond or provide requested information, they can provide the information now to have their coverage reinstated.
Individuals who can no longer qualify for Medicaid can access health care through other means, including employer-based insurance or on the federal health care marketplace, according to the department. Medicaid beneficiaries who need assistance can visit ar.gov/accessanywhere or they can call (855) 372-1084.
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 end of the month in which the federal public health emergency ends for anyone enrolled as of March 18, 2020, or after, 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 re-determining 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 Department of Human Services.
Within 180 days of the expiration of restrictions on the department's ability to dis-enroll individuals, such as those imposed by the federal Families First Coronavirus Response Act, Arkansas Act 780 of 2021 requires the state Department of Human Services 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 requirement.
State Department of Human Services officials have said they are not sure how many Arkansans will lose Medicaid coverage over this six-month period with Arkansas and other states returning to normal eligibility rules for Medicaid for the first time in three years as President Joe Biden ends the federal public health emergency.
Lesnick said there were 304,631 Medicaid beneficiaries in the extended coverage population as of Monday.
The state Department of Human Services 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 federal Affordable Care Act.