Concerned about disruptions in health coverage for private-option enrollees and children from low-income families, Gov. Asa Hutchinson said in a letter to state lawmakers Monday that he has instructed the state Department of Human Services to "bring in additional resources as necessary" to help with the annual check of eligibility for Medicaid benefits.
Hutchinson sent the letter to update lawmakers on an annual check of the incomes of about 600,000 Medicaid recipients, including tens of thousands of enrollees on the private option, that began a month ago using an electronic eligibility and enrollment system that has been under construction for more than two years.
The first round of checks using the system was delayed for months, resulting in a backlog of recipients whose eligibility needs to be checked before a Sept. 30 deadline set by the federal Centers for Medicare and Medicaid Services.
Calls from recipients about the eligibility checks have overwhelmed the Human Services Department's customer service call center in Batesville, department spokesman Amy Webb said Monday.
"One of our more pressing issues right now is, people have questions or need some more information, and they're not able to get through," Webb said.
She said the department is exploring options, including expanding the call center staff or hiring a company to handle some of the calls.
The department is using the eligibility and enrollment system to check state Department of Workforce Services records on the wages of recipients who have been enrolled for at least a year.
Recipients whose incomes appear to have changed by more than 10 percent since they were initially approved are given 10 days to provide pay stubs or other records showing they are still eligible for coverage. If they fail to do so, their coverage is terminated.
Webb said the coverage for more than 15,000 Medicaid recipients, most of them private-option enrollees, has been terminated so far.
The Human Services Department is required to reinstate the coverage if proof of eligibility is presented within 90 days, Hutchinson said in the letter.
"However, the initial indications are that an unexpectedly high number of families are not responding to the notices from DHS and that many children and adults who may still qualify for care will lose their coverage," the governor said.
Although the coverage can be reinstated, he said, "the removal and reinstatement process is cumbersome and could cause significant disruptions for families, health care providers, insurance carriers and the state."
He said the Human Services Department "will partner with insurance carriers, providers and advocates to get the word out that individuals must respond to DHS in a timely manner if they believe they still qualify for coverage."
He said he has also instructed the department to "bring in additional resources as necessary to handle the greatly increased volume of customer inquiries."
An Arkansas Democrat-Gazette reporter obtained a copy of the letter from Twitter after Sen. Jason Rapert, R-Bigelow, posted it in late Monday afternoon.
"I put that out basically for constituents in my district, hoping that they would take notice and read the letter, and if it affects them or their families that they would respond," Rapert said.
The eligibility checks are the first to be conducted with the system built by the Human Services Department to handle enrollment under federal eligibility rules that went into effect Jan. 1, 2014, under the 2010 Patient Protection and Affordable Care Act.
The rules govern the eligibility for about 600,000 Medicaid recipients, including more than 250,000 Arkansans who enrolled after becoming eligible for coverage under the expansion of the state's Medicaid program and more than 300,000 children from low-income families.
More than 218,000 of the newly eligible adults receive coverage through commercial insurance purchased with federal Medicaid funds under the private option.
The start of the first round of annual eligibility checks was delayed because of flaws in the IBM software used in the eligibility system and other difficulties the department encountered in building the $200 million system, department officials have said.
So far, the eligibility of about 125,000 Arkansans has been checked, Hutchinson said in the letter. He said "another 25,000 have been directed to renew their coverage either online or by visiting a county office."
Webb said that was a reference to children covered under the ARKids First Medicaid program. To keep the coverage, their families must visit a county office or state website, access.arkansas.gov.
The initial review "represents a step in the right direction on the development of this" eligibility verification and enrollment system, Hutchinson said in the letter.
He added: "Once the initial review is conducted through the information system, then a substantial amount of manual processing is required for those who have questions or are responding with additional information."
Webb said the amount of manual work is more than the department expected. The process should be streamlined as the eligibility system is improved, she said.
If a Medicaid recipient's coverage is reinstated within 90 days of the initial termination, it can be reinstated retroactively to cover medical expenses incurred after the initial termination, she said.
Those who lose their private-option coverage will have to re-enroll in a private plan, with the traditional Medicaid program covering expenses after the initial termination.
She said the department has begun sending out fliers with the renewal notices listing additional phone numbers people can call for more information.
"If we can divert some of the calls, and get them to the right place, that might help a little bit," Webb said.
Metro on 07/14/2015