Nearly 77,500 Arkansans lost Medicaid coverage in June because they either didn't return information needed to determine their eligibility or were no longer eligible, the state Department of Human Services reported Monday.
The Arkansans include 47,426 whose coverage had been extended previously because of special eligibility rules during the federal covid-19 public health emergency and 30,042 others whose coverage was discontinued as part of normal operations, according to the department.
The figures reflect the third 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 June, 50,366 Medicaid beneficiaries had their coverage renewed after their eligibility was confirmed under normal eligibility rules, the department said.
As of July 1, the state's Medicaid enrollment totaled 971,364, the department reported. That compared with 1,125,871 on April 1, according to the department.
The continuous coverage requirement meant no Arkansans could be removed from the 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 end of March 2023, the department reported 1,151,347 Medicaid beneficiaries.
"There is a lot of fabricated outrage and incorrect reporting about Arkansas' legally required efforts to redetermine eligibility for Medicaid recipients whose coverage was extended due to special rules during the COVID-19 Public Health Emergency that have since ended," state Department of Human Services Secretary Kristi Putnam said in the department's news release.
"This outrage is misplaced," she said.
"It's coming from out-of-state media and special interest groups, and it distracts from the reality that Arkansas is following a detailed plan developed over more than a year that is both fair and helps protect Medicaid resources for those who truly need it," said Putnam, who didn't name any particular out-of-state media and special interest groups in the department's news release.
Loretta Alexander, health policy director for Arkansas Advocates for Children and Families, said Monday in a written statement, "Our concern about children losing coverage is genuine."
"The number of kids who've lost health insurance -- about 27,000 each month ... -- is alarming, and it far exceeds anything health advocates expected," she said. "That's due in part to the artificially sped-up process required by our Legislature. Other states that have seen massive numbers of children losing coverage have paused their procedural enrollments so they can try to gather more information about what is happening."
Arkansas Advocates for Children and Families, like other state and local groups, has been raising concerns and awareness for more than a year about the state's rushed process for disenrolling people following the end of the Public Health Emergency, Alexander said.
"Instead of brushing our concerns aside, the state needs to pause procedural terminations immediately," she said. "It's very likely that the vast majority of children who lost ARKids A coverage, which serves the state's lowest-income families, are still eligible for another program like ARKids B, which has higher income eligibility criteria. But now, those kids' time-sensitive medical appointments, immunizations, screenings, and treatments will be delayed. Delay in medical care for children is serious, and it will cost the state additional money to re-enroll these eligible kids."
Department spokesman Gavin Lesnick said Monday night the department is following federal and state laws and every state must come into compliance with normal eligibility rules since President Joe Biden ended the federal public health emergency and states cannot stop the process.
"We began messaging to beneficiaries to prepare for the end of the PHE in April 2022 -- more than a year ago," he said in a written statement. "We are using every tool to make sure families who are eligible remain covered, while also working to ensure that those who are no longer eligible can get coverage through their job or the healthcare marketplace.
"We check all categories of eligibility during the redeterminations using an automated verification process and information provided by the beneficiary," Lesnick said.
He said special emphasis has been put throughout this process on reaching families with children covered by Medicaid, including providing lists of patients at risk of being disenrolled to pediatricians; sending materials to be distributed to families through school districts, school nurses, agency partners, and libraries; calling families covered by ARKids directly, and partnering with community-based organizations across the state, including many that directly serve children and families.
According to the department, the Medicaid beneficiaries who were disenrolled in June included 38,945 who failed to return the renewal form, 9,291 who failed to return requested information and 5,391 who requested their coverage be discontinued.
In addition, the department reported that 8,339 Medicaid beneficiaries had a household income above the limit for their household size, and 3,856 did not meet the requirements of the program.
The department said in its news release that "[n]ational groups" have pointed to the number of procedural disenrollments, which includes beneficiaries who did not return their renewal packets, but 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 is likely that many others simply will not return their packet because they are aware that their case will close given their change in circumstances," according to the department. "A closure because of a procedural reason does not mean that the packet was not received or that the beneficiary was unaware of this process."
The number of disenrollments is tied to multiple reasons, including two minimum wage increases in Arkansas during the pandemic and a drop in the unemployment rate from 4.9% in March 2020 to 2.7% in May of 2023, the department said.
The department reported that 29,243 of the 77,468 Medicaid beneficiaries who were disenrolled in June were in the state's Medicaid expansion program called ARHOME, 20,666 were in the ARKids A program and 16,715 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 4,379 Medicaid beneficiaries disenrolled in June were newborns, and 1,754 were in the ARKids B program.
As of July 1, the department said 414,722 children are Medicaid beneficiaries, 276,764 adult beneficiaries are on ARHOME, and 279,878 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 expects "tens of thousands" of Medicaid beneficiaries to be removed from the Medicaid rolls because they don't meet eligibility requirements.
In April, the Human Services Department's then-Chief of Staff Mark White told lawmakers that department officials didn't know whether 50,000, 150,000 or 200,000 Arkansans will lose Medicaid coverage over this six-month period with Arkansas and other states returning to normal eligibility rules.
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.
A month 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, an Arkansas Department of Human Services spokesman countered that extensive efforts have been made and are continuing to be made to ensure the beneficiaries know what to expect.