U.S. to state: 10 days too few
Medicaid recipients now getting 30 to provide income data
A federal agency has directed the Arkansas Department of Human Services to give Arkansans more time to prove they remain eligible for Medicaid benefits.
Under a change ordered by the federal Centers for Medicare and Medicaid Services, the Human Services Department will give recipients 30 days to provide pay stubs or other income records instead of 10 days, department spokesman Amy Webb said Friday.
The change grants a reprieve to about 17,000 Medicaid and private-option beneficiaries whose coverage had been set to end Tuesday because they had not provided the requested records within the previous 10-day deadline.
Those recipients will be sent new notices giving them an additional 30 days to provide the records, Webb said.
The changes came after the Centers for Medicare and Medicaid Services “changed its guidance” on how the state should conduct reviews of recipient income, Webb said.
The state began reviewing recipient income in mid-May as part of what is supposed to be an annual redetermination of eligibility for the health insurance provided through Medicaid.
Gov. Asa Hutchinson had defended the 10-day deadline, saying that was the amount of time Arkansas Medicaid recipients traditionally have been given to respond to such information requests.
“The state of Arkansas will follow the most recent federal regulatory directive concerning the redetermination of enrollees on Medicaid,” Hutchinson said in a statement Friday. “It is my hope that no more changes in guidance will come from Washington in the near future.”
A spokesman for the federal agency didn’t return a
message seeking comment on the directive.
As a result of the federal instructions, Webb said, the Human Services Department has temporarily halted its check of the income of private-option enrollees and other Medicaid recipients who have been signed up for at least a year.
The department suspended the income checks late last week after the Centers for Medicare and Medicaid Services officials said they would be giving the state “changed guidance,” Webb said.
The income reviews will resume after the department revises its notices to reflect the 30-day deadlines, she said.
Sen. David Sanders, R-Little Rock and a sponsor of the law creating the private option, called the change “good policy.”
Rich Huddleston, director of Arkansas Advocates for Children and Families, said in a statement that the 30-day deadline “not only aligns with federal regulations, but also prioritizes the health and financial security of thousands of Arkansas families.”
But Huddleston also called for further changes, including reinstating coverage for those already terminated simply because they had not responded to previous 10-day warning letters.
Webb said the Centers for Medicare and Medicaid Services didn’t request the reinstatement of those coverages.
She didn’t know whether the department’s computerized enrollment and eligibility-verification system would be capable of such a task.
She noted that recipients who provide proof of their eligibility within 90 days after their coverage is terminated can have the coverage reinstated retroactively.
As of Friday, 58,895 recipients had received termination notices, including about 35,000 whose coverage ended Aug. 1.
Only 2,306 of those who have received termination notices were found to be ineligible.
The remaining 56,589 had failed to provide income-related records to the department.
Coverage has been reinstated or was not terminated for 3,286 recipients who received termination notices but later provided records showing they were still eligible.
If the department doesn’t reinstate coverage for those who received the 10-day notices, it should at least send the former recipients notices reminding them that they can have the coverage reinstated if they submit proof of income within 90 days of the termination, said Marquita Little, director of health care policy for Arkansas Advocates for Children and Families.
The department also should improve the wording on its notices, she said, and the Legislature should reconsider the state’s ban on funding for outreach workers who could educate private-option enrollees about the income reviews.
The department has revised the notices to make them easier to understand, Webb said, adding that she would contact Little to get further suggestions.
She said she didn’t know whether the department would send additional notices to those whose coverage has been canceled.
Pay stubs or other records are requested when wage records from the state Department of Workforce Services are not available or indicate that the recipient’s eligibility status has changed since the recipient was first approved.
In such cases, federal regulations require a state to send the recipient a “pre-populated renewal form” and to give the recipient at least 30 days to complete and return the form.
The department’s enrollment and eligibility-verification system is unable to generate such forms, Webb said.
Human Services Department officials have maintained that the 30-day requirement applies only to the pre-populated forms and not to requests for income-related records.
The department’s notices gave recipients 10 days from the date of the notice to provide the requested records.
If the records weren’t provided within 10 days of the deadline given by the notice, the recipients were sent a second notice informing them that their coverage would end.
In an email to state Medicaid Director Dawn Stehle on Thursday night, Judith Cash of the Centers for Medicare and Medicaid Services acknowledged that Arkansas officials told the federal agency about the state’s plan for conducting the income verifications “late last year” and that the state has been giving recipients 1020 days to provide information.
Citing federal regulations, Cash wrote that Arkansas should “revise its renewal notices, explaining the information needed from the beneficiary to determine eligibility, and give the beneficiary at least 30 days to respond with the required information.”
Cash is director of the federal agency’s Children and Adult Health Programs Group’s Eligibility and Enrollment Division.
Originally expected to begin last fall, the state’s income reviews were delayed by seven months because of difficulties the Human Services Department has encountered in building the enrollment and eligibility-verification system.
The new system is needed to conduct the income checks according to rules that went into effect on Jan. 1, 2014, under the 2010 Patient Protection and Affordable Care Act, Human Services Department officials have said.
At Hutchinson’s direction, the department earlier this month stopped sending out cancellation notices to Medicaid recipients for two weeks to allow the department to catch up on processing records that had been submitted by recipients.
Hutchinson cited “anecdotal” reports that some enrollees’ coverage had been terminated even though they remained eligible and had provided information requested by the Human Services Department.
Arkansas Blue Cross and Blue Shield and Centene Corp. later said they would continue covering prescription drugs for 30 days for customers whose private-option coverage ended July 31 or was set to end Tuesday for failure to provide income-related records to the Human Services Department.
The companies said they would treat medical claims during the 30-day extended coverage period as “pending.”
If an enrollee’s Medicaid eligibility is not reinstated within the 30-day window, the companies will pay for the drugs, but not for the medical services.
The companies won’t receive monthly premiums for the extension for enrollees whose coverage is not reinstated.
Under the private option, the state uses Medicaid funds to pay the premiums and provide other subsidies for adults with incomes up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.
The Centers for Medicare and Medicaid Services had given Arkansas until Oct. 1 to catch up on starting the annual income checks. By that time, Human Services Department officials have said the department was to have started the checks for almost 600,000 recipients.
In the email Thursday, Cash said her agency would “entertain” an extension of the Oct. 1 deadline.
The Human Services Department will request an extension, Webb said.