A rally at the state Capitol on Wednesday tried to drive home the message that Arkansas’s beleaguered Medicaid verification process is resulting in some very real physical pain for low-income Arkansans.
Arkansas Advocates for Children and Families, Citizens First Congress, and the Interfaith Alliance called for the governor to reinstate coverage to nearly 60,000 people that have lost health insurance since June.
The state is embarking on its first attempt to verify income eligibility since Medicaid expansion was adopted. The Department of Human Services has said many people are likely still eligible for coverage but failed to respond in time or for some DHS may have failed to process it. Others claim to have never received a letter at all.
Randy Dollar of Jacksonville is one of them. He said the moment he discovered he lost his health insurance he literally had a mouth full of blood. The 53-year-old said a pharmacist told him after having a procedure to prepare for heart surgery.
“I had a heart valve put in and they wanted a dental clearance. When I went in they pulled twelve teeth, packed my mouth full of gauze,” he said. “I already had IVs hanging out both arms then they gave me two prescriptions. One for pain pills and one for antibiotics. I go down to the pharmacy to get them filled, in the same building, and then they said, ‘your insurance is terminated.’”
Dollar said he was informed by the pharmacy on August 3rd, just two days before his scheduled heart surgery. He said the clinic that performed his open-heart surgery checked his coverage in mid-July, before it was terminated, so the procedure wasn’t canceled.
Following surgery Dollar said he couldn’t follow medical advice about recovery because he couldn’t afford necessary prescriptions. The lapse in coverage nearly cost his life for the second time.
“This glitch almost killed me two or three times,’ Dollar said. “I couldn’t fill my prescriptions, and this is one day out of heart surgery. I got a handful of prescriptions and I can’t fill them. Four days later I went to the emergency room at Arkansas Heart Hospital.”
After facing a medically dangerous and financially burdensome gap in coverage Dollar said he was eventually able to appeal his termination, submit income verification and had his coverage re-instated. The governor’s office has noted that those who have received termination notices have 90 days to appeal and can recoup costs.
Dollar said he never received a letter from the Department of Human Services requiring proof of income to be submitted within 10-days of when the request was initiated at DHS.
Arkansas has twice offered major adjustments to the process. The governor previously enacted a two-week moratorium to help DHS deal with an “information overload” and increased staff levels. Envelopes and the message on the DHS letter have also been reconfigured, designed to be more understandable.
Two of three private insurance companies have also offered to continue prescription coverage, with the agreement the state will reimburse them if individuals are later found to in fact still have been eligible for Medicaid after termination.
That continued pharmacy benefit does not extend to very low-income people, children, and the medically frail on traditional Medicaid, rather than the states private option version of Medicaid expansion. The director of AACF Rich Huddleston estimated 8,000 poor children and 8,000 medically frail are among those with newly terminated plans.
Last week federal officials directed Arkansas to extend the 10-day window to 30 days. In recent weeks Governor Hutchinson repeatedly defended the 10-day time limit saying it “invigorated” the process. However, Arkansas still made the switch to 30 days. It does not retroactively applied to the 59,000 people who already lost coverage under the old rules.The executive director of Arkansas Citizens First Congress said the governor needs to give everyone on Medicaid the same window of time.
“They don’t have health care coverage for unfair reasons. The governor should reinstate those people immediately,” said Kopsky. “Then go through it, because we agree that people that don’t qualify do need to be weeded out of the system. There’s no doubt about that but it needs to be done consistently, fairly, and effectively and they haven’t met any of those standards.”
Arkansas Advocates for Children and Families director of health policy Marquita Little said the process of Medicaid redetermination could go more smoothly if Arkansas invested in better outreach efforts. The Republican controlled Legislature banned outreach funding in 2014 for some aspects of the Affordable Care Act.
“We had a pretty robust marketing, education, outreach process in place previously using federal grant dollars. We had over 500 in-person assisters working around the state and helping people in their communities. Now we have 15. There were commercials and radio spots but what’s happened since that time is that private organizations have had to try and fill in that gap. It’s been a much more limited amount,” said Little. “We saw that it worked, that’s how we got so many people enrolled originally.”
Arkansas cut its uninsured rate more than any other state in the nation since the ACA was adopted. It dropped from 22 percent to just over 9 percent from 2013 to midyear 2015.