Medicaid rule frustrates advocates for homeless

Homelessness service providers said they are confused and frustrated when it comes to filing for exemptions and reporting hours worked to the state so their homeless clients can keep their health insurance.

At Wednesday’s monthly meeting of the Arkansas Homeless Coalition, advocates said a difficult-to-maneuver filing system for good-cause exemptions related to homelessness, slow responses to phone calls for help and a website that isn’t always functional made the reporting process challenging.

Arkansas Works enrollees between the ages of 30 and 49 must file evidence of either 80 hours of work per month or other approved activities. The federal government approved the state’s work requirement in March. About 27,000 enrollees were initially affected and more will be included in the requirement in coming months.

More than 7,000 people were out of compliance in June, the Arkansas Democrat-Gazette reported last month. After three months of noncompliance, Medicaid beneficiaries will be dropped from the program until the start of next year when they can reapply.

Kevin De Liban, a staff attorney with Legal Aid of Arkansas who works with Medicaid issues for the nonprofit, said September will

be a critical month for an estimated 5,000 to 7,000 Medicaid enrollees.

He said it can be particularly difficult for homeless people to figure out how to file the work-requirement data.

De Liban said it wasn’t clear how the good-cause exemption should be filed, and that he’s fielded many calls from people who have had trouble reporting to the Arkansas Department of Human Services.

Legal Aid of Arkansas is a nonprofit that provides legal services to low-income people in civil cases, its website say.

Although homelessness is not specifically listed under the good-cause exemption for the work requirement, DHS representatives told coalition members at their July meeting that homelessness would be considered under that exemption. DHS officials have attended homeless coalition meetings twice to discuss the work requirements.

“Administrative hoops lend themselves to failure,” De Liban said of the new reporting requirements.

Bruno Showers, a health care policy fellow with Arkansas Advocates for Children and Families, said he has presented to groups like the homeless coalition about a dozen times over the past year, and almost everyone has told him that they are confused, particularly when it comes to the good-cause exemption. Arkansas Advocates is a nonprofit that does research and advocacy work focused on the well-being of children.

That confusion, De Liban said, stems from the fact that there is no opportunity for users to check “good cause” as an exemption on Access Arkansas, the DHS reporting website.

Marci Manley, a spokesman for the department, said goodcause exemptions should be emailed to AWGoodCauseRequest@dhs.arkansas.gov so officials can consider them on a case-by-case basis. The email should include contact information for the person sending the email, the client’s contact information, the month the event warranting an exemption occurred and a description of what happened.

There are two types of goodcause exemptions. The first is if the recipient had a reason for not reporting, such as inclement weather shutting down Internet connections. The second is if recipients experience life circumstances that keep them from fulfilling the work requirements.

Circumstances listed in the Arkansas Works special terms and conditions documents are:

If beneficiaries or others in their home have disabilities or serious illnesses.

If the beneficiary experiences the birth or death of a family member living in the same home.

If there is severe inclement weather.

If the beneficiary has a family emergency or other life event.

Homelessness could fall under “other life event,” according to the DHS desk guide on the good-cause exemption. The guide uses as an example, an enrollee who is homeless and doesn’t get the notice to report. The enrollee can have someone who can attest to their homelessness contact the Human Services Department.

But for Paul Atkins, an associate pastor at Canvas Community Church, helping the homeless report the hours they’ve worked has proved difficult outside of the good-cause exemption.

Atkins filed as a registered reporter, meaning that he is certified to report for Medicaid clients who may not be able to navigate the website or access the Internet.

As of Wednesday, there were 189 people who had been authorized as registered reporters, according to DHS data.

On a weekend before the August deadline, Atkins filled out the online paperwork for a woman who lives in her car.

Atkins said that when he submitted the woman’s work hours — she had gotten the job late in the month and hadn’t fulfilled the requirements — he didn’t get any confirmation that he had completed the process correctly.

“I’m distressed now to find out it may not have been working at all,” Atkins said. “That steals days, depending on how the calendar works. It steals opportunity.”

De Liban and other advocates said the Web portal doesn’t work at night and is often down for maintenance on the weekends.

“There are periods where maintenance has to be conducted, but it’s daily available from 7 a.m. to 9 p.m. unless a scheduled maintenance is going to occur,” Manley said Wednesday.

DHS compliance documents state that all maintenance will take place during the weekends for “minimal disruption.”

Advocates at the meeting who said they are registered reporters said they are regularly unable to access the site on weekends and have difficulty after 7 p.m., but nights and weekends are often the time they are available to help people fill out the forms.

De Liban said many of his clients also have had to wait up to 10 days for a call back from the number listed to call for help with Access Arkansas. He said he’s tried calling with clients, and left messages that weren’t returned without multiple calls.

Manley said she wasn’t aware of any problems with a backlog of messages but needed to check with the group that runs the Access Arkansas call center. The department was not able to provide answers about a message backlog by Wednesday evening.

Homelessness advocates have just less than a month to figure out the system before the next round of reporting requirements begins Sept. 5.

“I just have more questions as to whether it’s actually working or not, and I don’t even know who to ask,” Atkins said.