More than 82,000 Arkansans lost Medicaid coverage in July because they either didn’t return information needed to determine their eligibility or were no longer eligible, the Arkansas Department of Human Services reported Tuesday.

The Arkansans include 39,967 whose coverage had been extended previously because of special eligibility rules during the federal covid-19 public health emergency, and 42,312 others whose coverage was discontinued as part of normal operations, according to the department.

The figures reflect the fourth month of Medicaid eligibility redeterminations following 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 during normal eligibility rules.

Besides those who were disenrolled in July, 50,609 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules, the department said.

The department’s critics maintain too many children have lost coverage during the past four months, but department officials counter they have worked extensively with the aim of making sure that eligible children keep their Medicaid coverage, while those who no longer qualify find access to health care from other sources.

As of August 1, the state’s Medicaid enrollment totaled 915,926, the department reported. That’s compared to a total enrollment of 1,125,871 on April 1, according to the department.

The state’s total Medicaid enrollment has dropped by nearly 210,000 during the past four 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 next six months, 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.

Department Secretary Kristi Putnam said Tuesday in the department’s news release, “We are now more than halfway through our six-month unwinding process, and during this time our dedicated county operations team has confirmed eligibility for more than 200,000 Arkansans.

“This is exactly how the system is supposed to work: we are ensuring that benefits remain available for Arkansans who truly need them, and we are also working to make sure those who no longer qualify know about available options for health care coverage,” she said. “As we move forward, we remain committed to completing this redetermination process in a way that is both efficient and fair.”

The department said it’s expected that beneficiaries who are no longer eligible for Medicaid will be disenrolled during this unwinding process.

While some of these individuals will return their renewal packet and confirm that they no longer qualify, it’s likely that many others will not return their packet because they are aware their case will close given their change in circumstances, the department said in its news release.

“A closure because of a procedural reason does not mean the packet was not received or that the beneficiary was unaware of this process,” the department said.

CHILDREN’S COVERAGE

Loretta Alexander, health policy director for Arkansas Advocates for Children and Families, said Tuesday night that more than 100,000 Arkansas children have been disenrolled from their ARKids First health coverage since April 1.

“We know that many, if not most, of those children should still be eligible for the program,” she said in a written statement, so “we need an all-hands-on-deck approach to ensuring that every child who is eligible is re-enrolled or finds alternate coverage as soon as possible.

That means state agencies, health providers, schools and advocates all need to work together during this back-to-school season to ensure that every eligible child has ARKids coverage, said Alexander, who has been a critic of the department’s handling of the Medicaid unwinding process.

“Since the Legislature chose to shorten the timeline for this redetermination process, and since it hasn’t followed the lead of some other states in pausing procedural disenrollments, our state has chosen to make this more difficult for families than it had to be,” she said.

“We want all of Arkansas’ kids to be attending school, ready to learn. When a kid shows up to school sick, the whole classroom can be affected. For healthy schools, our students need access to preventive, primary and acute care without delays,” Alexander said.

Department of Human Services spokesman Gavin Lesnick countered that the department has worked for more than a year to prepare for the unwinding process.

This work has included significant outreach aimed at ensuring that eligible children and families maintain their Medicaid coverage, while those who no longer qualify find access to health care from other sources, he said.

“We remain committed to these efforts and are working with partners across the state to complete all redeterminations fairly,” Lesnick said in a written statement. “We encourage families who are no longer eligible for Medicaid to obtain coverage through the federal Health Insurance Marketplace or an employer-sponsored plan, and we are confident that many of those who have been disenrolled have already done just that. Families who believe they have been disenrolled in error and think they may still be eligible can visit ar.gov/cover for information about requesting to have their coverage reinstated.”

According to the department, the 82,279 Medicaid beneficiaries who were disenrolled in July included 36,751 who failed to return the renewal form, 19,149 who failed to return requested information and 4,143 who requested their coverage be discontinued.

In addition, the department reported that 9,837 Medicaid beneficiaries had a household income above the limit for their household size, and 2,944 did not meet the requirements of the program.

The department reported that 33,011 of the 82,279 Medicaid beneficiaries who were disenrolled in July were in the state’s Medicaid expansion program called ARHOME, 21,147 were in the ARKids A program and 16,072 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 3,945 Medicaid beneficiaries disenrolled in July were newborns, and 1,822 were in the ARKids B program.

During the past four months, the department has reported a total of about 300,000 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 a total of about 200,000 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules.

TOTAL ENROLLMENT DETAILS

As of August 1, the department said 398,726 children are Medicaid beneficiaries, 254,200 adult beneficiaries are on ARHOME, and 263,000 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 of 2021 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.

Two months ago, a federal Medicaid official said 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. At that time, Lesnick said that extensive efforts have been made and are continuing to be made to ensure beneficiaries know what to expect.

Beneficiaries who need assistance can call (855) 372-1084 between 7 a.m. and 7 p.m. Monday through Saturday, according to the state Department of Human Services. They can also submit questions through the Access Anywhere form at ar.gov/accessanywhere, or visit ar.gov/renew for additional information.

Arkansans who are no longer eligible for Medicaid can transition to an employer-sponsored plan, or one available on the federal Health Insurance Marketplace, according to the Department of Human Services. The Health Insurance Marketplace may reach out directly, but Arkansans can apply for coverage immediately by visiting healthcare.gov. Most applicants will qualify for tax credits or cost-sharing reductions that help subsidize the cost of a federal plan.

Additional information is available at ar.gov/cover.