Children in Ark. losing COVID-era Medicaid care
One in five children on Medicaid in Arkansas lost their coverage during an “unwinding” — the period in which Medicaid's COVID-era Continuous Coverage Protections were phased out.
That's according to a report released Thursday by Georgetown University's Center for Children and Families.
During the COVID-19 pandemic, states were given extra federal funding in exchange for keeping people enrolled in Medicaid who might otherwise lose their coverage.
Arkansas was among the states with the highest percentage drop in people covered by Medicaid when this arrangement ended, especially among children.
Arkansas was sixth in the country in terms of reductions in child Medicaid (and the related Children's Health Insurance Program or CHIPS) enrollment and fourth among states that had lower child enrollment at the end of 2023 than in 2019.
In absolute numbers, Arkansas, with 94,002 fewer children on Medicaid by the end of the unwinding period, was close behind New York, which lost 105,953.
Why did so many people lose Medicaid coverage in Arkansas?
“Arkansas moved very quickly in comparison to other states,” beginning the unwinding process before many other states and finishing it sooner, said Joan Alker, executive director of the Center for Children and Families and an author of the report.
Tricia Brooks, another author of the report, said that “there were only a handful of states that chose to go faster than the 12 months that [the Centers for Medicare and Medicaid Services] said they were allowed,” Arkansas among them.
“What happened in the states that went fast, is they didn't have time to monitor the impact and have a rapid response to make sure that eligible people were not being disenrolled, particularly for procedural reasons,” Brooks said.
Alker reiterated that the speed itself of the process can actually lead to more people being disenrolled than if was more drawn out.
“The more people that you put through the process, the more pressure there is on the eligibility workers, on the call centers that are taking calls from families who need help … the more likely it is to get backed up,” Alker said.
When the system gets backed up, people might not be able to access the resources they need to go through the steps they need to in order to confirm their eligibility, Alker said.
Brooks said many people new to Medicaid during the pandemic didn't know how to renew their coverage.
"There was a three-year hiatus on disenrollment people came into the program, newly, and had never gone through a renewal previously, so they really had no clue what was happening," Brooks said.
Brooks said wait times to talk to someone one by telephone could be as long as several hours and people working in person during the day might not be able to reach anyone for help at all because of that.
"States will often say it's a failure on the part of the beneficiary," she said. "But we know from years of evidence that there are a lot of things that don't work very well in in Medicaid, including notices" and portals to upload documents, which sometimes glitch.
Gavin Lesnick, chief communications officer at the Arkansas Department of Human Services, declined to comment except to say that state law required Medicaid eligibility to be determined within six months of the end of the COVID-19 public health emergency and that the department began to prepare for the unwinding process a year in advance.
“Arkansas followed the Medicaid unwinding process as required by federal and state law," he said in a statement. "We believe that maintaining access to uninterrupted health coverage for children is critical to their health and wellbeing, and Arkansas has made significant efforts to ensure that every eligible child and family in the state maintained coverage.”
Arkansas Department of Human Services Secretary Kristi Putnam said in a written statement in September that by "discontinuing coverage for beneficiaries who no longer qualify for Medicaid, we are ensuring that these resources are available to eligible Arkansans who truly need them.”
“I'm proud of the work that staff across our entire agency performed over the last six months to ensure that our program is serving only those who truly need Medicaid," she said. "And I'm excited to finally put the pandemic and the special rules that had been in place behind us so we can focus on serving Arkansans under normal eligibility operations going forward.”
What will this mean for those who lost coverage?
Alker said it is bad for children's health to go uninsured and "it exposes the families to high medical bills that they can't afford, even going a few months without coverage."
Mance Buttram, a professor of public health at the University of Arkansas, said that if “people aren't getting preventative care or they're delaying care until it is an emergency” because they don't have insurance coverage, that could lead to “people having to seek out much more urgent care or much more serious care, because they have not been able to access it."
“That could potentially put a strain on healthcare resources," Buttram said.
“There's data to show adequate health care accessibility during childhood, that could lead to lasting consequences maybe related to life expectancy or some health and social problems," he said.
Alker said that the technical problem of a lack of health care coverage for children will also be a problem with a long tail.
"It's going to take time, but community-based partners and stakeholders and pediatricians and clinics and schools are going to have to deal with the consequences of this and trying to get children re-enrolled," Alker said.
“Kids are not expensive for our society to cover," she said. "But they require regular care.”