Spotlight Exclusives

Arkansas Drops Thousands From Rolls in Medicaid Unwinding

Neil Sealy Neil Sealy, posted on

States across the nation are grappling with what is being called the Medicaid unwinding—the end of the pandemic-era policy that guaranteed Medicaid benefits for eligible users without the need for annual recertification or income evaluation. The Washington Post reported that nearly 4 million people have lost coverage already—most for procedural issues. No state has moved faster to implement the policy than Arkansas where an estimated 200,000 people have lost coverage. Neil Sealy, executive director at the Arkansas Community Institute, spoke with Spotlight recently about the situation there; the transcript has been lightly edited for clarity and length.

Give us a sense of what is happening on the ground in Arkansas.

Well, Arkansas has the shortest timeline for the unwinding and my sense is they want to knock as many people off Medicaid as they can. Healthcare has always been a big part of our agenda, and we’ve been reaching out to people as much as we can. But what we’re seeing, first of all, is that since renewal is all remote, that’s causing very, very big problems, particularly for people who don’t have internet access or can’t navigate computers. Enrollment is all done by phone, computer, and mail, and so you never really get to talk to anyone. You can imagine that with a short timeline and starting with over a million people on Medicaid in the state, that’s going to knock a lot of people from the rolls.

I guess I should have you explain exactly what the unwinding means.

The public health emergency unwinding is that during the pandemic, people were allowed to stay on Medicaid, even if their income increased. And so, the end of the public health emergency kicked off the process of now determining people’s eligibility for different Medicaid programs. The state had begun telling people earlier through mail, but often, the letters that people get are often difficult to decipher. And people moved; low-income people who rent move more frequently and towards the end of the pandemic here in Arkansas, we found that evictions were skyrocketing.

The other issue that we’re seeing is, and I think even the department acknowledges, is that there a lot of glitches and mistakes from the computer program that they use.

Does this essentially mean that everyone has to reapply if you are a Medicaid recipient or only those that are asked to do so by the state?

They don’t have to reapply, but just send in their information.

You have to reestablish your income.

Exactly. Some people may have turned in their info before the end of the public health emergency, but we have uncovered situations where someone has turned in their current address, but the computer system still sends it to another address. If you’re caught in that trap, it’s very, very difficult—it takes a lot of effort to get the right information into the system and that has caused people to lose their health coverage. People also are supposed to be provided with options in the Obamacare marketplace if they’re not eligible, but I’ve seen no evidence that the Department of Human Services is really providing people with that.

And how much time has the state given folks for this process?

They have six months from the end of the public health emergency, which was April 1, so it will be October 1.

What’s your sense at this point of how many people have been dropped from the rolls?

I didn’t compute in the June report, but I think we’re getting close to 200,000 so far. And the interesting thing is that most of those are due to insufficient paperwork.

And from the perspective of groups like yours, what are you finding are the most effective ways to help people with this? Is it just simply trying to let people know that they have to do this?

It’s more than that. We have had to use direct action, and we’ll continue to use that and push the state to do a better job—that’s the most effective way to get the word out. We’ve also distributed tens of thousands of flyers in several cities. We have radio public service announcements. We’re just looking at ways to get some changes. There will be a special legislative session coming up and we would like to push the legislature to lengthen the time requirement and then we have advocated for navigators in each department of Human Services office to help people get through this. But they are refusing to do that.

The state also has filed a new work requirement with CMS (Centers for Medicare and Medicaid Services) that will move people out of our expanded Medicaid program and back into traditional Medicaid if they aren’t in compliance. Arkansas expanded Medicaid in a peculiar way, though in some ways it made sense for the state. People can use the Medicaid expansion to buy insurance from the marketplace, and in one sense, that’s good because we’re a rural state and providers that take Medicaid directly are limited. It’s more expensive than the state’s traditional Medicaid but increases your range of services and providers.



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