Benefits-eligibility denials draw look

2 state panels vote to review vendor’s Medicaid-care assessments contract

A pair of legislative committees on Tuesday voted to conduct a special review next month of the state’s contract with a vendor hired to perform assessments used to determine eligibility for Medicaid benefits for the elderly and disabled.

The vote by the Senate Committee on Children and Youth and the House Committee on Aging, Youth, Legislative and Military Affairs came after lawmakers heard testimony about the hundreds of Arkansans who have been found ineligible as a result of the assessments, which started in January.

“Obviously there are serious problems here that we need to address, sooner rather than later,” said Rep. Charlene Fite, R-Van Buren, the House committee’s chairman.

Fite said she asked the state Department of Human

Services for an update on the assessments after receiving calls from constituents and reading an article about the issue in the Arkansas Democrat-Gazette on June 3.

Holding up some papers, Rep. Dan Douglas, R-Bentonville, said, “I have a whole stack of denied people out here.”

Those facing the loss of benefits include people who have have sold their homes and “have no place to go back to” if they’re forced to move out of assisted-living facilities, he said.

“I’m appalled. I am simply appalled at the mess that we have,” he said.

The Human Services Department hired Optum Government Solutions in 2017 to perform the assessments, using a tool based on one developed in Minnesota.

The assessments started in January of this year for two Medicaid programs. One is the assisted-living program, which serves up to 1,200 people in 59 facilities around the state.

The other is ARChoices, which provides in-home care, including help with daily living tasks such as dressing and bathing, to about 8,800 Arkansans.

Previously, Human Services Department nurses performed assessments for the two programs using a different tool, known as ArPath.

Of the 331 people who have been assessed for eligibility for the assisted-living program this year through May 30, 146, or 44%, were found to be ineligible, Mark White, deputy director of the department’s Aging, Adult and Behavioral Health Services Division, has said.

Those found to be ineligible included 78, or 47%, of the 165 residents assessed this year who had previously been found eligible after assessments using ArPath, and 41% of the 166 new applicants who were assessed.

Similarly, 951, or 31%, of the 3,047 Arkansans assessed for eligibility this year for ARChoices were found to be ineligible.

That included 27% of those who had been previously found to be eligible and 37% of the new applicants.

Luke Mattingly, chief executive of CareLink, the Central Arkansas Area Agency on Aging, said that those found to be ineligible for in-home care include an 81-year-old woman who uses a wheelchair, is incontinent and lives alone, and an 89-year-old blind man who also lives alone and has difficulty communicating.

“It doesn’t take a rocket scientist to walk into these people’s homes and realize they need help,” Mattingly said.

Recipients can ask for their services to continue while appeals are pending, he said, but many don’t exercise that option because the Human Services Department tells them they could be responsible for paying for the cost of their services if the appeal is denied.

Bethany Wilkins, a case manager for the Area Agency on Aging for Western Arkansas, said one couple in Mountainburg lost their in-home services in March as a result of assessments that were conducted in January.

A hearing on the couple’s appeal of the termination of services is set for December, she said. In the meantime, she said the woman told her last month that she hadn’t had a bath in two weeks because she can’t bathe without assistance and her husband is unable to help her.

She also had been to the hospital twice because “no one is there to make sure she gets her medications on time,” Wilkins said.

Last month, the department announced that it will review all the assessments that have resulted in a Medicaid recipient being disqualified for services.

Over the past three weeks, the department has reviewed 287 of the assessments and it hopes to complete the rest by the end of this month, White told lawmakers on Tuesday.

The department will contact recipients to clarify any discrepancies between the Optum assessment and the previous assessment conducted using the ArPath tool, he said.

In cases in which the department can spot an error that led to a disqualification, it will fix the mistake and reinstate the recipient’s benefits, White said.

In other cases, it may have Optum perform another assessment of the recipient at no additional cost to the state, he said.

Even before the review was announced, White said the department had been working with Optum to improve the training of the firm’s nurses who perform the assessments. Some who were “not meeting their quality requirements” were fired, he said.

The department has also worked to improve communication between its own nurses to make sure it was making consistent decisions based on the assessments.

Optum’s contract called for

“It doesn’t take a rocket scientist to walk into these people’s homes and realize they need help.”

— Luke Mattingly, chief executive of CareLink, noting that those found to be ineligible for inhome care include an 81-year-old woman who uses a wheelchair, is incontinent and lives alone, and an 89-year-old blind man who also lives alone and has difficulty communicating

it to be paid up to $25.5 million from July 1, 2017, through June 30 of this year, with all but $7.7 million of that coming from the federal government.

Human Services Department spokesman Amy Webb said the contract was extended for two months without adding to its cost. The department is working on making changes to the contract’s performance requirements before it submits a further extension to the Legislative Council for review.

In a voice vote on Monday, with no members dissenting, the Senate Committee on Children and Youth and the House Committee on Aging, Youth, Legislative and Military Affairs decided to conduct their own review of the contract.

Fite said after the meeting that those committees will make a recommendation to the council and Review Subcommittee.

She said she wants to examine qualifications of the Optum nurses and the criteria used to determine eligibility.

In response to her suggestion, White said during the meeting that the Human Services Department “could certainly look at” grandfathering in recipients who were previously found to be eligible using ArPath.

Such a change, however, would require a change to the waivers authorizing the ARChoices and assisted-living programs, he said.

Sen. Bart Hester, R-Cave Springs, said it’s important to ensure that the services only go to those who are eligible.

He noted that the assessments are part of a plan to reduce state spending on the traditional Medicaid program to help pay the cost of expanding benefits to nondisabled adults with incomes of up to 138 percent of the poverty level.

“We do a lot of these things that are tough because we’re trying to be responsible with taxpayers’ money,” he said.