State to 4,798: Error will end care coverage

Help is offered to get some back in expanded Medicaid

About 4,800 people who were mistakenly enrolled in Arkansas' expanded Medicaid program before their eligibility had been verified have been notified that their coverage will end Saturday, a spokesman for the Arkansas Department of Human Services said Thursday.

The enrollees submitted applications through the online federal enrollment portal, healthcare.gov. Their eligibility was never verified, but Arkansas officials didn't realize that when the state received information on the applicants from the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services, said Amy Webb, a spokesman for the state Human Services Department.

Those who were mistakenly enrolled likely include people being covered under Medicaid-funded private plans under the state's so-called private-option program, as well as people assigned to the traditional Medicaid program because their health needs are considered exceptional, Webb said.

She said she didn't have information on how many of the 4,798 enrollees affected are in each program.

She said her department sent the enrollees letters on May 21 notifying them that their coverage will end at the end of this month.

Some of those receiving notices may still be eligible for Medicaid coverage but must go to the federal website to provide additional information needed to verify their eligibility, Webb said.

If they are ultimately found eligible, they would not face a gap in coverage because the Medicaid program will pay for up to three months of past medical expenses after an applicant is approved.

Those who do not qualify for Medicaid may be eligible for federal tax-credit subsidies to help them buy coverage on the state's health-insurance exchange.

Although enrollment on the exchange ended for most people on March 31, being dropped from the Medicaid program will count as a "qualifying event" allowing people to enroll after the deadline, Webb said.

"What we anticipate is that many of these people will end up actually coming back to the private option," Webb said. "Because we were notified that there was not a fully verified application, we had to end the coverage until they went in and completed that process."

Those mistakenly enrolled are among more than 170,000 people who had been approved for coverage under the expanded Medicaid program as of April 30.

The expansion, approved by the Legislature last year, extended eligibility to adults with incomes of up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.

Under the private option, most people who are approved for coverage can sign up for a private plan on the exchange, with Medicaid paying the premium and providing additional subsidies to reduce or eliminate the recipient's out-of-pocket costs for medical care.

Webb said the enrollment error happened after the Centers for Medicare and Medicaid Services began including information about applicants whose eligibility had been classified as "pending verification" in a data file that also included information on approved applications.

"They apparently put in some code or indicators in there, unbeknownst to us," marking which applicants' eligibility had not been verified, Webb said.

"That was not something we knew to check for," she said.

The Arkansas agency said in a news release that its staff discovered the error after noticing "missing information and income levels that would exclude people" from eligibility.

Arkansas officials began asking their federal counterparts about the matter in April and learned about the error this month, Webb said.

She said an applicant's eligibility could be listed as unverified because the federal agency needs additional documentation, such as a driver's license to verify the applicants' identity or a tax return to verify income.

She said those receiving the notices should go to healthcare.gov or call a federal call center at (800) 318-2596 to supply the missing information.

She said she has heard reports that some people have faced obstacles to completing their applications because federal records list them as being already enrolled. Arkansas officials are working to resolve the problem, she said.

"For the next day or two, it may be more difficult unless [the applicants] can get to a call-center worker who's actually familiar with the issue," Webb said.

She said Arkansas officials also are working with federal officials to ensure that those who are ineligible for Medicaid can sign up for other coverage on the exchange that would take effect as soon as the premium is paid. Normally, coverage would not start until July 1 for someone who signs up in late May or early June.

Operators at the Arkansas Insurance Department's call center have received about 20 calls this week from Medicaid enrollees who received the notices, Insurance Department spokesman Heather Haywood said.

She said the call center's four staff members can direct people to resources such as healthcare.gov or an outreach worker or insurance agent who can provide one-on-one help, Haywood said.

The state call center's number is (855) 283-3483. Information on outreach workers and insurance agents licensed to help with enrollment is also available on a department website, ahc.arkansas.gov.

People with questions about their Medicaid coverage can also call a Human Services Department call center at (855) 372-1084, Webb said.

Webb said the state will not attempt to recoup any money from those who were mistakenly approved for coverage, and state officials don't believe that Arkansas will have to reimburse the federal government for payments made on the applicants' behalf to insurance companies or health-care providers.

The federal government is expected to pay full cost of providing coverage to those covered under the expanded program until 2017, when Arkansas will begin paying a part of the cost.

"We got the information and processed it in good faith," Webb said.

A section on 05/30/2014

Upcoming Events