More than 50,000 Arkansans this year had their Medicaid coverage terminated, despite the fact that many of them were in fact eligible for the program, because they were flagged by the state’s troubled new eligibility-and-enrollment system and failed to respond to income-verification letters quickly enough. Around a quarter of them have now provided the necessary paperwork, been deemed eligible, and had their coverage reinstated. But it remains unclear how many of the remainder — those still without coverage — are Medicaid eligible. 

In testimony before the Legislative Health Reform Task Force yesterday, John Selig, director of the Department of Human Services, said that DHS and the Arkansas Center for Health Improvement (ACHI) have been calling a sampling of those who lost coverage and haven’t yet been reinstated. The calls, made to hundreds of beneficiaries with still-cancelled coverage, specifically targeted private option beneficiaries. The governor requested that the calls be made in order to try to determine more information about this group. 

Selig testified that they have thus far been able to reach around a quarter of the hundreds that they’ve called. Of those they reached, most fell into two categories: people who now had coverage through something else, such as a new job or Medicare, and people who were still in the process of getting reinstated (some may be waiting on DHS, some may be planning to send reinstatement paperwork but haven’t done so yet, etc.).  He didn’t provide any further information about how many fell into each group, and DHS officials told me today they do not yet have further details. In other words, some of the folks they reached may be actually ineligible (someone who has a new job that pays too much to qualify for the program), but others who lost coverage are likely actually eligible based on what they told the callers. Keep in mind that in addition to flagging certain changes in income, the DHS system also flagged anyone who had no income at all according to the state’s own data, which would make them Medicaid eligible. “Some of them will be coming back on,” Selig said. “We don’t know how many at this point.”

Meanwhile, 40 percent of those called had bad numbers — disconnected or wrong numbers. It’s possible that some have moved out of state (in which case they’re no longer eligible) but many more may have moved within the state or simply have changed numbers or had their number disconnected. Altogether, 75 percent of those called were never reached — either because of bad numbers or because they never picked up (callers tried getting in touch at least three times, at different times of day). This group is a complete mystery in terms of eligibility. 

“The biggest takeaway from trying to reach those people is that this is a very transient population,” Selig testified yesterday. He said that this signaled to state officials that they needed to check more often — to check addresses more frequently and to do more ongoing eligibility verification. He also said that perhaps the department needed to come up with better ways to communicate with these beneficiaries. 

I’d suggest one more takeaway that Selig didn’t mention. Given that this is an extremely hard-to-reach, transient population; and given that this was brand new program for hundreds of thousands of people, many of them with health insurance for the first time in their adult lives; and given that the state had no outreach program in place to try to get in touch with these beneficiaries — perhaps it was not such a good idea to impose a 10-day response deadline in the first place. In the end, it turned out that the 10-day deadline violated federal regs, and the feds stepped in to require a longer window. Coverage terminations have ceased while DHS changes its process in the wake of the feds’ ruling. But nothing was done to retroactively help those who lost coverage under the old system. That still leaves tens of thousands without coverage, even though many of them are apparently income eligible according to the state’s own data.

Here’s a breakdown of where things stand: In total, just over 60,000 people have been removed from the rolls. A fraction of those (a little more than 4,000) were removed because DHS actually determined that they were ineligible (most of these would be people who moved or died). The remaining 56,605 people had coverage terminated because they did not respond in time to the 10-day income-verification letters (in practice, beneficiaries had a little longer to reply before coverage was actually ended).

Of those 56,605, so far 14,646 have been reinstated. That means that despite being flagged by this process, they were in fact eligible. They’ve contacted DHS, provided the necessary information, had their paperwork processed, and gotten coverage restored.

That leaves around 42,000 who have had coverage terminated and have not been reinstated. Some of them may have sent paperwork to DHS but are still waiting to be processed (anecdotally, there are still eligible beneficiaries in this waiting line; DHS officials said they did not have information about how many people might still be waiting to have reinstatements processed). Some, surely, are legitimately not eligible — and those who know they are not eligible probably won’t bother to ever get in touch with DHS. But that still leaves many, including those with no income at all, who are still eligible but for whatever reason have not yet sent their paperwork in to be reinstated. If they need medical care or medication, they’ll be out of luck.