More than 72,000 Arkansans lost Medicaid coverage in August because they either didn't return information needed to determine their eligibility or were no longer eligible, the Arkansas Department of Human Services reported Friday.
The Arkansans include 34,961 whose coverage had been extended previously because of special eligibility rules during the federal covid-19 public health emergency, and 37,558 others whose coverage was discontinued as part of normal operations, according to the department.
The figures reflect the fifth month of Medicaid eligibility redeterminations 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 to unwind the state's Medicaid rolls that runs through the end of September. Normal eligibility rules resumed April 1.
In contrast, the state Department of Human Services said the department would disenroll about 20,000 to 30,000 ineligible individuals a month on normal eligibility rules.
Besides those who were disenrolled in August, 50,662 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules, the department said.
Department of Human Services Secretary Kristi Putnam said Friday that "We have now completed redeterminations for five of the six months of our unwinding effort, and so far our incredible eligibility workers have confirmed eligibility for more than a quarter of a million Arkansans.
"By discontinuing coverage for beneficiaries who no longer qualify for Medicaid, we are ensuring that these resources are available to eligible Arkansans who truly need them," she said in a department news release.
Several states have been ordered by the federal Centers for Medicare and Medicaid Services to pause their redeterminations or reinstate coverage for some beneficiaries because of issues with their eligibility system processes, but Arkansas is not one of those states and the state Department of Human Services anticipates continuing to fulfill its comprehensive unwinding plan over the sixth and final month, according to the department.
The department noted that "the 34,961 closures for beneficiaries whose coverage had previously been extended due to the [public health emergency] special eligibility rules are the fewest monthly closures during the unwinding to date.
"The top reasons for closures include disenrollments based on beneficiaries failing to send back required eligibility information," the department said.
It's likely many beneficiaries did not return their renewal packets because they were aware they are no longer eligible because of a change in circumstances, the department said. A closure caused by failure to send in information does not mean the packet was not received or that the beneficiary was unaware of the requirements for this process, the department said.
COVERAGE FOR CHILDREN
For the past five months, the department's critics have argued that too many children have lost coverage during this period.
Keesa Smith, executive director of Arkansas Advocates for Children and Families, said Friday in a written statement that "We continue to be alarmed at the sheer number of children who have lost their ARKids First insurance.
"More than 125,000 children have lost coverage at some point over the past five months," she said. "We are particularly worried that parents may not have understood that their children are still eligible for a Medicaid-funded program even though the adults in the family are not, because the income eligibility levels are different for kids and parents. We urge the state to shift its efforts to aggressively reach out to families to ensure that these children have access to coverage, whether it's re-enrolling in ARKids or helping them to enroll in private Marketplace coverage. When children's health is on the line, we cannot afford delays or red tape."
Department of Human Services spokesman Gavin Lesnick countered Friday that the department began reaching out to beneficiaries about the unwinding more than a year before the end of the public health emergency.
"We have made outreach to families a top priority throughout this process, and we have worked to ensure that children who are eligible for Medicaid keep their existing coverage or transition to another program for which they qualify," he said in a written statement. "Our process includes a step to check the eligibility of the individual child even if the adult is no longer eligible. We will maintain this focus as we conclude the unwinding and as we continue normal eligibility operations going forward so that children who need services provided by Medicaid have access to them."
As of Sept. 1, the state's Medicaid enrollment totaled 877,544, the department reported. That's compared with a total enrollment of 1,125,871 on April 1, according to the department.
The state's total Medicaid enrollment has dropped by about 248,000 during the past five months.
In April, officials at the state Department of Human Services didn't know whether 50,000, 150,000 or 200,000 Arkansans would lose Medicaid coverage during the six-month unwinding period, the department's then-Chief of Staff Mark White told the House Revenue and Taxation Committee.
The continuous coverage requirement meant no Arkansans could be removed from 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 that their coverage end.
According to the Human Services Department, Arkansas' Medicaid rolls increased by more than 230,000 during the pandemic. At the end of March 2020, the department reported 921,066 Medicaid beneficiaries. At the end of March 2023, the department reported 1,151,347 Medicaid beneficiaries.
Nicholas Horton, founder and chief executive officer for the Opportunity Arkansas group, said Friday that "Thankfully [the Department of Human Services] and the Sanders administration have worked tirelessly to restore integrity to the Medicaid program and make it more sustainable for the long term.
"Frankly, the work they've done is impressive -- and something the rest of the country is watching," he said in a written statement. "We need a strong Medicaid safety net for the truly needy and thankfully our Medicaid program is significantly stronger today than it was just six months ago. That's something every Arkansan should be proud of."
According to the department, the 72,519 Medicaid beneficiaries who were disenrolled in August included 36,858 who failed to return the renewal form, 10,130 who failed to return requested information and 5,003 who requested that their coverage be discontinued.
In addition, the department reported that 7,466 Medicaid beneficiaries had a household income above the limit for their household size, and 6,234 did not meet the requirements of the program.
The department reported that 26,520 of the 72,519 Medicaid beneficiaries who were disenrolled in August were in the state's Medicaid expansion program called ARHOME, 19,586 were in the ARKids A program, and 10,207 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 3,088 Medicaid beneficiaries disenrolled in August were newborns, and 3,810 were in the qualified Medicare beneficiary program.
During the past five months, the department has reported that a total of about 370,000 Arkansans lost Medicaid coverage because they either didn't return information needed to determine their eligibility or were no longer eligible. During the same period, the department reported that a total of about 250,000 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules.
TOTAL ENROLLMENT DETAILS
As of Sept. 1, the department said 388,558 children are Medicaid beneficiaries, 239,990 adult beneficiaries are on ARHOME and 248,996 other adults are Medicaid beneficiaries.
On April 1, the department said 469,142 children were Medicaid beneficiaries, 334,866 adult beneficiaries were on ARHOME, and 321,863 other adults were Medicaid beneficiaries.
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 will be phased out gradually by the end of this year.
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 was sponsored by state Sen. Scott Flippo, R-Mountain Home, who has said he had expected "tens of thousands" of Medicaid beneficiaries to be removed from the Medicaid rolls because they don't meet eligibility requirements.
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.
If beneficiaries believe their case was closed in error, they can visit ar.gov/cover for information about asking to have their coverage reinstated if they are still eligible, reapplying or appealing the determination, according to the state Department of Human Services.
Beneficiaries who need assistance can call (855) 372-1084 from 7 a.m. to 7 p.m. Monday through Saturday, the department said, adding that they also can submit questions through the Access Anywhere form at ar.gov/accessanywhere, or visit ar.gov/renew for additional information.