Mike Wickline of the Arkansas Democrat-Gazette reports today on critical comments made by Daniel Tsai, a top Medicaid official in the Biden administration, regarding Arkansas’s push to “unwind” health coverage for tens of thousands of people enrolled in the government-funded insurance program under special pandemic-era rules that have since expired.

The state Department of Human Services has ended Medicaid coverage for over 140,000 Arkansans in just the last two months, many of them children.

Tsai gave credit to Arkansas DHS for trying to reach out to beneficiaries on the verge of losing coverage. But he expressed concerns about the state trying to move as quickly as possible:

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.”

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Tsai made the comments in a phone call with reporters on Friday, Wickline writes.

Medicaid is a joint federal-state effort. Though it’s funded primarily by the feds, each state also kicks in a substantial amount of money and has a good deal of control over how their Medicaid program operates on a day-to-day basis. But states ultimately have to follow the rules set by the U.S. Centers for Medicare and Medicaid Services, or CMS, where Tsai is a deputy administrator and director.

It’s only to be expected that all states will remove large numbers of people from Medicaid now that the federal “public health emergency” over covid-19 has ended. Under emergency rules during the pandemic, CMS told states they couldn’t kick people off Medicaid coverage for various things that would otherwise render them ineligible, such as a rise in household income above the typical eligibility threshold. That meant Medicaid rolls have swelled with people with “extended” coverage under the emergency rules.

The question is how states go about reverting back to normal eligibility rules, post-emergency. Do they kick off beneficiaries in the “extended” group as fast as they can? Or do they unwind things slowly, so as not to disrupt the lives of thousands of families who have come to rely on Medicaid to pay for pediatrician visits and prescriptions?

Arkansas seems to be prioritizing speed above all else, in part because of a bill passed by the state legislature in 2021.

“The unwinding is required under state law to be completed within six months of the April 1 end of the continuous coverage requirement that had been in effect under the Public Health Emergency,” DHS spokesman Gavin Lesnick told the Arkansas Times on Friday. As of June 9, there are still approximately 240,000 beneficiaries in the extended category, he said.

Many Arkansans now losing Medicaid coverage may indeed no longer be eligible because their life circumstances have changed: They’ve gotten a new job and are making too much money to qualify, they’ve found health coverage elsewhere, etc. But DHS’  recent numbers suggest many or most of the closures could be for procedural reasons rather than underlying eligibility.

Out of the 69,000 Arkansans who lost Medicaid coverage in May, about 32,000 had their cases closed because they failed to return a renewal form, according to a DHS report issued last week. Another 10,000 failed to provide the agency with some other piece of requested information. Some of those people might well still be eligible (they can reapply for coverage, though that can be a lengthy process).

More than 25,000 of those who lost coverage in May were children enrolled in ARKids or another Medicaid-funded program.

The comments from Tsai suggest CMS officials are keeping a close eye on Arkansas’s situation. Meanwhile, the state recently sent CMS a proposal to make major changes to its waiver governing Arkansas’s Medicaid program for low-income, able-bodied adults. The state wants to create a scaled-back, gentler version of former Gov. Asa Hutchinson’s 2018 Medicaid work requirement, which resulted in many thousands of disenrollments before it was halted by a federal judge (and eventually scrapped by the Biden administration).

In its new proposal, which DHS submitted to CMS on June 1, the state repeatedly insists it will NOT use the lite version of the work requirement to kick people off Medicaid. “Individuals will not lose Medicaid eligibility,” Gov. Sarah Sanders flatly said in a letter accompanying the proposal. But might federal officials feel a bit more skeptical about that claim in light of Arkansas’s move-fast-and-break-thing approach to unwinding extended coverage post-pandemic?