Arkansas Democrats criticize DHS’ handling of post-pandemic Medicaid “unwinding”
From the Arkansas Advocate:
Arkansas Democrats will focus on the state’s revocation of hundreds of thousands of Arkansans’ Medicaid coverage during the 2024 election cycle, party leaders said in a Tuesday press conference.
The state Department of Human Services didn’t do enough to ensure people, especially children, were no longer eligible before revoking their health insurance, Grant Tennille, chairman of the Democratic Party of Arkansas, told reporters.
DHS spent six months reviewing the eligibility of Medicaid recipients whose coverage was extended for three years due to the COVID-19 pandemic, even if they no longer qualified for benefits because of income or other eligibility limits.
More than 184,500 of the roughly 420,000 Arkansans who retained coverage during the extension were disenrolled between April 1 and Sept. 30 because they did not provide necessary eligibility information, according to data DHS has released every month since May.
“Before you go taking health insurance away from children, you better know they’re not eligible,” Tennille said. “It shouldn’t be, ‘Well, we couldn’t get in touch with you, so you’re not eligible.’”
The nationwide Public Health Emergency (PHE) enacted at the start of the pandemic ended May 11. In April, DHS began “unwinding” the extension by disenrolling clients they considered ineligible.
Some clients made too much money to qualify for Medicaid anymore, and others asked to be disenrolled, according to DHS’ monthly data reports.
DHS Secretary Kristi Putnam said in a statement Tuesday that she is “excited to finally put the pandemic and the special rules that had been in place behind us so we can focus on serving Arkansans under normal eligibility operations going forward.”
She also said she is proud of DHS’ efforts “to ensure that our program is serving only those who truly need Medicaid.”
Tennille said this is “a lie” based on the number of procedural disenrollments.
“To say the only people left on the rolls are those who truly need Medicaid, you either don’t understand the program you run or you’re lying to the people of Arkansas,” Tennille said.
Both Tennille and House Minority Leader Tippi McCullough, D-Little Rock, called on elected Republicans, who control the Legislature and the executive branch, to restore Medicaid coverage to recipients that DHS could not reach.
“We are already the highest-need state, and our policy for the past six months has been to strip the very children in most need of healthcare,” McCullough said. “We have to fix that broken system.”
Those who believe they are still eligible for Medicaid can reapply or seek more information via the DHS website or a DHS questionnaire, DHS communications chief Gavin Lesnick said. They can also call 855-372-1084 to reach the department’s call center that is still active after the unwinding.
Outreach and obstacles
More than 1 million Arkansans, about a third of the state’s population, were receiving Medicaid benefits at the start of April. That number was 868,059 as of Oct. 1, Lesnick said.
DHS started reaching out to Medicaid clients who benefited from the coverage extension last year, before the unwinding began. As of July 17, 2022, DHS had tried to call 281,497 individuals whose coverage had been extended due to the PHE. Through those calls, the agency confirmed or updated 39,106 addresses, the Arkansas Advocate reported in August 2022.
Medicaid clients could also update their contact information by calling the Update Arkansas hotline at 1-844-872-2660 or visiting DHS’ benefits site.
DHS repeatedly called, texted and emailed Medicaid beneficiaries “at many different points in the renewal timeline” to try to obtain eligibility information, Lesnick said. The department also tried to reach people through snail mail, social media, community organizations, healthcare providers who serve Medicaid clients and a call center run by DHS staff.
Some beneficiaries’ eligibility could be verified using “automated renewals that involved passively checking data against existing verification sources rather than requiring beneficiaries to return any information,” Lesnick said.
Putnam’s predecessor, Mark White, said in November 2022 that determining Medicaid clients’ eligibility would be difficult if they did not respond to DHS’ requests for information.
“We don’t have any good way of knowing for these folks if they are no longer eligible or if they’ve just not responded to their renewals,” White said.
Arkansas Community Organizations has held several protests this year airing Medicaid recipients’ complaints, not just about the unwinding but also about the need for broader health care coverage from the program, a less cumbersome application process and better customer service.
Some Medicaid recipients have said they never received notice from DHS that their coverage was in jeopardy before losing it. Neil Sealy, an organizer with Arkansas Community Organizations, reiterated this at the press conference Tuesday.
In August, organizers wrote a letter to Daniel Tsai, director of the Center for Medicaid and the Children’s Health Insurance Program (CHIP) within the federal Centers for Medicare and Medicaid Services, asking him to work with Arkansas officials on improving the state’s administration of benefits.
The advocacy group delivered the letter to the offices of Arkansas’ two U.S. senators, John Boozman and Tom Cotton.
Sealy said Tuesday that neither senator has responded to the letter and neither has Tsai.
Arkansas Community Organizations asked DHS in March to include a one-year grace period in the unwinding, to no avail.
States have started their unwinding projects at different times, but Arkansas is the only state that planned to finish the project in fewer than nine months, according to a January 2023 survey from health policy researcher KFF.
“High rates of terminations” nationwide during the unwinding has been concerning for U.S. Centers for Medicare and Medicaid Services officials, Tsai said in a June 14 nationwide conference call.
Most disenrollments were “for procedural reasons and largely for folks not responding to the renewals,” he said.
In August, Tsai asked some states to restore coverage to Medicaid clients who were disenrolled for procedural reasons, but Lesnick said the request did not apply to Arkansas.
Arkansas has one of the nation’s highest shares of children in rural areas covered by Medicaid, according to a Georgetown University study published in August.
About 35% of Arkansas’ disenrolled Medicaid clients from April through July were children, according to data collected by KFF.
McCullough pointed out that a state agency would be able to locate and contact many Medicaid clients through their local schools if those clients have school-aged children.
A 2014 state law forbids DHS from applying for or accepting funds, including federal funds, “for the purpose of advertisement, promotion, or other activities designed to promote or encourage enrollment” in state-run health insurance programs.
Tennille said this law was a poor policy choice. He added that the loss of Medicaid coverage for those who are eligible has a ripple effect on education, the economy and public safety.
“Not treating people when they’re sick, not giving people preventative health care while they’re young is going to end up costing [the state] millions more than we would spend on Medicaid,” he said.