How bad the Medicaid enrollment crisis really is
4 min read

How bad the Medicaid enrollment crisis really is

Safety Net
May 3
4 min read

Since early 2020, states — including Arkansas — have been barred from removing virtually anyone from their Medicaid programs.

If their income skyrockets, they can’t be removed. If they inherit a billion dollars, they can’t be removed. Even if they were improperly enrolled to begin with, they can’t be removed. And this has been the case for more than three years.

Many of these individuals have been on the program since the beginning of the pandemic, maybe initially qualifying because of a job loss, but then going back to work as the economy started to reopen. But even though they want back to work and their incomes came back up, they couldn't be removed from Medicaid. So some individuals may have been incorrectly receiving taxpayer-funded Medicaid benefits for more than three years.

Thankfully, beginning April 1st, states were finally re-empowered to start cleaning up their Medicaid rolls.

Read Part 1 of our series here that explains what redeterminations are and why they are so important.

Arkansas is far better positioned than other states because, thankfully, the state never stopped doing reviews during the pandemic (even though they couldn't take action to remove ineligible enrollees). This gives them a head start on identifying likely fraud and allows them to be more strategic as they try to dig their way out of this mess.

But this task is daunting, because the situation is far worse than the media has let on.

First, not only is enrollment at an all-time high — with roughly one in every three Arkansans on the Medicaid program — but the Arkansas Department of Human Services's internal estimates suggest more than 420,000 enrollees are likely ineligible.

That’s nearly 40 percent of the state’s Medicaid enrollment. Every dollar spent on one of these individuals is a dollar that can’t go towards the truly needy, or towards other priorities like public safety, transportation, education, or income tax relief.

Second, of these 420,000 likely ineligible enrollees, roughly half are able-bodied adults of working age. In other words, because able-bodied adult enrollment has swelled so significantly, the “unwinding” of these ineligible enrollees will be focused on this population and not the truly needy Arkansans (such as those who are aged or disabled).

Virtually all of the individuals that will be removed already have access to free or low-cost private insurance, either through their employer or through the federal health exchange.

Thankfully, Arkansas has put forth an aggressive redetermination schedule that 1) unwinds the Medicaid mess swiftly and 2) prioritizes the removal of non-vulnerable ineligible persons on the program.

Already, Arkansas has lost countless resources because of the federal Medicaid restrictions. But now that the federal handcuffs are finally off, the state is moving expeditiously to get its Medicaid program under control.

It is long past time to reorient Arkansas’s Medicaid program to focus on the most vulnerable, not those who are not even eligible for coverage. Thankfully, that's exactly what the Sanders administration is doing.

This article is Part 2 in a series on the importance of Medicaid redeterminations and program integrity. To view other stories in this series, simply click the #ReclaimARSafetyNet hashtag below.

Image of the story authorHayden Dublois
Visiting Economist

Hayden Dublois is the Visiting Economist at Opportunity Arkansas. His primary research areas are welfare, health care, workforce, unemployment, and tax policy.

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