COMMENTARY

The urge to purge

I am told that the state Human Services Department is in the process of purging perhaps tens of thousands of persons from the state’s popular private-option form of Medicaid expansion.

The action is pursuant to the first round of an income and eligibility verification process for all of Medicaid ordered by the Legislature in 2013.

So far the state has notified, in stages, 64,000 Medicaid recipients—the vast majority of them private-option participants—that an income check indicates they are now above the eligibility limit.

Of that number, 15,775 have failed to respond within the requisite 10 days to reassert their eligibility, and have been removed. That process is continuing, and the state expects more purges daily as the 10-day response deadline passes for more enrollees.

The federal government allows an additional 90-day review period in some contested cases.

I’ve been advised that the private-option purges might actually reach 50,000. That would be a fifth of the program’s vaunted enrollment of a quarter-million poor people.

State policymakers are walking around wondering if this means the program is less successful than they thought or just more efficient.

Political opponents of the private option will say the news proves the program has been, and is, a disastrous waste. Political advocates of the program will say strict conservatives can’t have it both ways—asserting the program is bad because it’s wasteful and then asserting the program is bad because it’s eliminating waste.

It will be a blow to the state’s private insurers to lose tens of thousands of customers whose premiums have been paid by the government. It could be a blow to hospitals, if those persons were actually using their insurance and not burdening providers with uncompensated care, and if those persons now can’t afford or otherwise don’t buy insurance for themselves with federal subsidies on the health-care exchange.

Naturally, the news may be a blow to poor people needing health insurance and who are losing it either because they’ve added a few seasonal dollars to the household treasury or simply don’t know how to respond to a letter from the state telling them they have 10 days to prove they’re still poor enough.

And there is that other looming ramification to consider: The development portends something—nobody is quite sure what—for the prospects of the state’s continuing Medicaid expansion by another name and different rules after 2017.

Either this development means the government can’t run anything right because maybe 50,000 people have been getting their insurance premiums paid though they weren’t eligible, or it means the government is monitoring this operation pretty well to find 50,000 persons ineligible.

Liberals will explain that the loss of even 50,000 would still leave 200,000 persons of genuine eligibility, and they’ll doubt that all those 50,000 actually are ineligible.

Maybe some got better jobs in the last year, which would be a good thing. Maybe some got only a fleeting seasonal boost to their payable hours. Maybe some are still actually eligible but—because of the transient nature of many poor folks—no longer residing at their last known addresses. Thus they’d be oblivious to an ominous government demand to respond within 10 days to re-establish their eligibility or lose it. They’d find out only on their next trip to the doctor.

People with incomes less than 138 percent of poverty, and thus eligible for the private option, can easily land new work that pushes them above 138 percent of poverty.

But those people could just as easily lose that work.

Maybe the dollar store increases a working mom’s hours. And maybe it scales back her hours next month.

There is a punitive nature to such rigid regular income checks. But, really, it’s hard to argue that we shouldn’t enforce the rules.

But I predict we’ll eventually learn that a sizable fluctuation in eligibility over a year is simply the norm, the nature of unskilled labor, the ordinary ebb and flow.

This new push for more vigilant income re-verification, or re-determination, was mandated by the Legislature in 2013 at the insistence of the young Republican architects of the private option.

More rigid monitoring of ongoing eligibility was a contingency demanded most prominently by Sen. Jonathan Dismang of Beebe before he would embrace the private option that he, Sen. David Sanders of Little Rock and former Rep. John Burris of Harrison are credited with championing.

Here was the deal: Accept the Obamacare money to expand Medicaid by the state’s own innovative and market-driven way, meaning through the purchase of private insurance, but only if we set up a system to monitor eligibility better than ever before.

Regardless of how all that turns out, the state will still keep at least a couple hundred thousand people on this program for now. And the governor and the Legislature will still face the question of what to do for those people in 2017 when, according to the governor and leading legislators, the private option ends.

Ideally, more and more working people would earn their way to ineligibility year after year, and the state would continue the program for the remaining neediest while realizing savings.

But the first step will be to decide on a prevailing spin for this purge.

What I’m sure of is the underlying truth, which is that this is a spectacularly successful program whether for 200,000 or 250,000.

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.

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