Protesters rally against the state's Medicaid purge in March 2023 Brian Chilson

The New York Times published a long opinion piece this morning about the situation facing Medicaid beneficiaries as states “unwind” special pandemic-era eligibility rules, ending coverage for millions of people.

Arkansas is front and center, as it often has been during the unwinding process. Every state is in the process of clearing their Medicaid rolls of potentially ineligible people, but Arkansas elected to do so within a span of just six months. Many of those who lost coverage were kicked off for “procedural” reasons, such as not returning a piece of paperwork — which they may have never received in the first place — and may in fact be eligible. (In fact, rising enrollment rates last month suggest that many people who were kicked off are now signing back up again.)

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The NYT piece features the story of Tamikka Burks, 35. A mother of two, Burks discovered she’d lost her coverage in mid-September when she went to a hospital emergency room. Then, journalist Bryce Covert writes, things got worse:

Ms. Burks discovered she was pregnant, a pregnancy that was considered high risk because she has high blood pressure. She takes two medications to keep her condition under control that can endanger a pregnancy further. Her doctor told her to switch to a different medication while she was pregnant, but without insurance it would cost about $45, instead of the $5 maximum copay she had spent under Medicaid. Ms. Burks, a 35-year-old single mother of two, doesn’t have anyone she could borrow that kind of money from, and “I literally have $50 from now until Friday,” she told me on a Tuesday.

She started taking just one of the two medications she was on, in the hope that it would be less dangerous, but she became too afraid of what it might do to her or the baby. In late September, she drove 10 hours round trip to Kansas to get an abortion.

“I don’t believe in abortion, so it doesn’t sit right with me at all,” she told me. She wanted three children and was excited for a new baby. But she was terrified of the health implications, afraid that if she kept her baby they would both die in the second or third trimester. “That would be just my luck,” she said.

Covert also tells the story of several other Arkansans, including Phyllis Wells, a disabled, nonverbal woman who requires full-time care. The state Department of Human Services has cut off her coverage twice in the past year, according to her brother. The first instance was “a mistake”; the second was caused by “a computer glitch,” the agency said.

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Such stories will be familiar to anyone who’s talked to Medicaid advocates in Arkansas over the past nine months. The state ended coverage for more than 400,000 people between April and October, a huge number in a state with just over 3 million residents. But DHS has responded with indignation at the suggestion that it could possibly have done anything wrong. In a typical statement yesterday responding to the Biden administration’s warning about 78,500 Arkansas children losing coverage, DHS Secretary Kristi Putnam called the letter “politically motivated.”

Putnam continues to insist that people who have been kicked off Medicaid have other options. “Many people who weren’t eligible for Medicaid have gotten coverage elsewhere, such as insurance through their employer or through the federal marketplace,” she said. “We believe that maintaining access to uninterrupted health coverage for children is critical to their health and well-being and Arkansas has made significant efforts to ensure that every eligible child and family in the state maintained coverage.”

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Compare that response to another Arkansas story documented by Covert. DHS kicked Sholonda Woods and her daughter, 16, off Medicaid in February. Covert writes:

Ms. Woods moved to Arkansas from Missouri three and a half years ago. To get back on Medicaid, Arkansas required her to get a letter from Missouri noting that her Medicaid case there was closed, which took months — getting through to Missouri’s Department of Social Services required staying on the phone for two or three hours, she said.

After that, Arkansas made her get her former employer at a Days Inn, where she worked for just a month in September, to sign a form saying that she no longer worked there. Ms. Woods doesn’t own a car, so she had to take the bus a half-hour to the Days Inn, only to have her former boss refuse to sign.

It wasn’t until Ms. Woods spoke to a government official at a protest with the nonprofit Arkansas Community Organizations that she was able to get her coverage restored, in April. But her daughter’s case didn’t get fixed until August. For months, Ms. Woods was unable to get her daughter’s asthma inhaler or A.D.H.D. medication. “I was hurt. I was mad,” she said.

The question is whether the Biden administration is inclined to do anything about it. Federal Medicaid authorities have considerable power over how states run their programs, but the Biden administration has been remarkably slow in responding to the actions of states like Arkansas. Putnam and Gov. Sanders have noted, correctly, that the federal Centers for Medicare and Medicaid Services never once told Arkansas to pause its disenrollments during the state’s six-month race to end coverage for untold thousands of beneficiaries. Now that the purge is complete, the federal bureaucracy is finally waving a red flag. But the damage has already been done.

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