On Friday, the feds made crystal clear what we’ve been arguing for some time: the state’s 10-day deadline for beneficiaries to respond to renewal letters wasn’t just a disastrous policy decision, it was a violation of federal Medicaid regulations.
The state is now switching to a 30-day deadline, which is very good news. However, more than 50,000 beneficiaries either had their coverage terminated — or will soon — under the state’s old 10-day policy, including some of the most vulnerable (the medically needy, very poor parents, kids on ARKids). Many or most of them are in fact Medicaid eligible. They will not be be reinstated by the state now, even though they were kicked off of the program in violation of federal law.
Under federal law, these beneficiaries have 90 days after the date of coverage termination to respond with the requested information and be reinstated to the program without having to re-apply. However, there is no guarantee that reinstatement will happen promptly, given the ongoing bureaucratic nightmare facing the state’s Department of Human Services. Tens of thousands of beneficiaries are without coverage right now, with tens of thousands more coming in two days, on September 1 — even if they send their information to DHS, they’ll be stuck playing a waiting game while they face gaps in access to care with potentially dire consequences. Meanwhile, none of the DHS communications have made the 90-day reinstatement option clear to beneficiaries — and most of the letters that were sent were vague, confusing, or easily mistaken for junk mail. Many beneficiaries may be unaware of their options or even unaware that they’ve lost coverage.
To be clear, while the feds are mandating that the state fix the problem going forward, they are not requiring that the state automatically reinstate these beneficiaries who were already kicked off in violation of federal regulations. And if there’s one thing we’ve learned about Gov. Asa Hutchinson, it’s that he’s a firm believer in only doing the minimum required when it comes to protecting beneficiaries.
I asked DHS whether, under the circumstances, the state might choose to reinstate them and start over with the proper 30-day (minimum) response window. DHS spokesperson Amy Webb said that this would be too logistically difficult:
Our system cannot not reopen all of these cases and then generate new notices. It’s not built to do that. Therefore it would require our caseworkers to handle 58,000 cases manually, which is not feasible at this time. It’s important to note that these folks do have 90 days to come back and provide the information and have their cases reinstated. They don’t have to appeal or do something special other than to just respond to our request. We will re-instated as soon as possible, if they are eligible.
Of course, it’s worth noting that it will also be logistically difficult for DHS to continue to implement this troubled system at the same time as it tries to deal promptly with tens of thousands of reinstatements. I have no doubt that DHS caseworkers will be diligently working overtime to get caught up, but we already know that there is a backlog when it comes to reinstating eligible beneficiaries who have sent in their paperwork (even including those who sent it on time in the first place). Delays are inevitable, meaning that eligible beneficiaries will be trapped in a waiting game, without coverage.
I cannot speak to the feasibility of automatic reinstatement (though a lawsuit could certainly force the issue). But the disturbing part of Hutchinson’s response to the unfolding disaster of tens of thousands of eligible beneficiaries losing coverage has been prioritizing the speed of purging the rolls over protecting eligible beneficiaries. His full-speed-ahead approach and insistence on the minimum required response time creates delays in reinstating eligible beneficiaries and puts them at risk with gaps in access to care (by the way, don’t hold your breath, but the state could choose to give longer than 30 days to beneficiaries, perhaps appropriate given this mess). This despite the fact that the state’s own consultant has suggested a more cautious approach. Two insurance companies are helping with a band-aid approach of offering pharmacy-only coverage, but this only applies to beneficiaries covered by those plans — approximately 30,000 of the coverage terminations. That leaves tens of thousands more without access to needed medication, including the most vulnerable patients.
DHS officials maintain that until a week ago, they believed that they were in compliance with federal regulations based on their communications with the feds. Fair enough, but now that the state knows that its trainwreck of a policy was not in compliance with federal law, you’d think that Hutchinson might place a renewed focus on reinstating eligible beneficiaries. But the priority seems to remain on rushing through the process. True, the state is already months behind, but that’s hardly the fault of beneficiaries.
The very least that the state should do — its first priority if it can not or will not reinstate those whose coverage was terminated in violation of federal regs — is to immediately send letters to the cancelled beneficiaries, informing them that they have 90 days to send in their information and get reinstated if eligible without having to re-apply (information that should really have been given out when they were cancelled in the first place!). DHS spokesperson Amy Webb told the D-G that she did not know whether the state would do so. Meanwhile, now that the 30-day deadline is in place, the state will have a sufficient window to do what it should have done for all beneficiaries from the get-go and send follow-up income-verification letters if they don’t get a response to the first letter. I asked Webb whether there were plans to do so; she said, “that is an option,” but didn’t comment on whether DHS would do so.
In fairness, it can take time to develop appropriate strategies. But let’s keep in mind that state officials first got word from the feds that the 10-day policy was violating federal regulations a week ago, on Friday August 21. You might think that upon finding out that the policy violated the law, the Hutchinson administration might spend the week coming up with a robust plan to communicate with the more than 50,000 who have lost coverage due to the faulty policy — and reinstate those who are in fact eligible as quickly as possible. Or, for that matter, developing a a stronger and more effective outreach effort to get in touch with these hard-to-reach folks. But, once again, priorities seem to be elsewhere.
“We’re a compassionate state,” Hutchinson said on “Capitol View” this weekend. That’s hard to square with his responses to the Medicaid verification mess.