If you’ve been paying attention to the Arkansas news lately, you’ve probably seen a lot of somber headlines like this one from the front page of last Sunday’s Arkansas Democrat-Gazette: “Some in Arkansas face loss of Medicaid benefits.”
Or this story, run by KARK, that exclaims “millions of vulnerable people will fall through the cracks and lose coverage” in the coming months.
Some Arkansas media outlets have even been camping outside local Department of Human Services offices to interview people, hoping to capture their outrage about what’s unfolding.
(This reporter caught nearly a dozen (!) people who are mad about Medicaid work requirements–which, as it turns out, unfortunately do not exist, although you would never know that from reading this story.)
But there’s one simple, important reason why this is all happening, which has been understated in all of these media reports when it’s even mentioned at all: people are leaving Medicaid because they don’t qualify for it. And removing them is a good thing, for many reasons.
Let's unpack this.
Medicaid redeterminations are as old as Medicaid itself. Quite simply, they’re an annual checkup on enrollees to make sure they still qualify for the program. This process is a core, foundational component of maintaining integrity in the Medicaid program and ensuring that only those who are truly eligible can receive taxpayer-funded benefits.
The state contacts enrollees and asks them if they’ve experienced any life changes that might impact their eligibility for benefits. If they say yes, a further discussion is pursued so the state can ensure individuals truly still qualify for the program.
If, after a brief inquiry, individuals are found to be no longer eligible for Medicaid services, the state provides them with information regarding other types of health coverage they might qualify for, including other types of Medicaid benefits and heavily-taxpayer-funded coverage on the Obamacare exchange.
Redeterminations are an essential part of Medicaid because eligibility is fluid, based on a variety of factors. For example, there are a lot of different life changes that occur that can affect an individual’s Medicaid eligibility:
Enrollees are expected to report these changes to the state proactively, but that commonly does not happen. As a result, the state also shares a responsibility to touch base with enrollees and make sure they still qualify before their benefits are extended for another year.
But here’s a much more important reason Medicaid redeterminations are so important: people.
Because people–many of our neighbors–depend on the Medicaid safety net for literal survival. They have nowhere else to go. They have no other options. They’re people like my friend Skylar Overman, who have spent years and years struggling to get the care they need. Every penny spent on ineligible Medicaid enrollees is a penny that can’t go to help Skylar and people like her.
Here’s the bottom line: the only individuals who are going to permanently leave Medicaid are individuals who do not qualify for it. Any individuals who may be incorrectly removed can re-apply immediately and/or appeal.
And while I feel silly even having to say this, contrary to what news reports might lead you to believe, removing ineligible enrollees from Medicaid is a good thing. It means more resources for our neighbors (like Skylar) who have nowhere else to turn and it means fewer taxpayer dollars wasted on fraud.
Medicaid redeterminations, are noted, are as old as Medicaid itself. Individuals cycle out in and out of the program all the time, as their eligibility changes. But Arkansas has been largely unable to remove ineligible enrollees from the program for more than three years.
At the very beginning of the pandemic, Congress passed a law offering states extra federal funding so long as they agreed not to remove ineligible enrollees. Arkansas, and every other state, took the bait. As a result, for three years, Arkansas’s Medicaid enrollment has had nowhere to go but up, with more than 1 in 3 Arkansans now enrolled in the program — a number that is equally staggering and unsustainable.
Some Arkansans may have been ineligible for Medicaid for as long as three years.
For example, consider a middle-aged man named Jim who lost his job in March 2020 due to the pandemic shutdowns and layoffs. He may have qualified for Medicaid the day he applied, but as the economy began to rebound and the state began to reopen (quicker than those around us), he went back to work in July, putting his income above Medicaid limits.
But thanks to the enhanced federal funding and its strings attached, Jim has been on Medicaid for nearly three years, even though he wasn’t eligible for nearly three years.
The work Arkansas DHS is undertaking isn't somehow cruel or unusual — it's simply an effort to reverse this wrong and restore Medicaid for the truly eligible, which is longer overdue.
Roughly half of all likely ineligible enrollees in Arkansas are able-bodied adults. Very few are in vulnerable populations, such as elderly or disabled Arkansans. It is extremely unlikely that many truly needy Arkansans will be affected at all.
Even in the rare event that someone does get inadvertently removed because they failed to re-submit their paperwork, they can immediately re-apply with retroactive coverage.
However, as noted, the only individuals who are really at risk of losing coverage are those who have become ineligible for Medicaid. And even for those who do leave Medicaid, many will find free or low-cost coverage through their employer or through the federal health exchange. In fact, according to the left-leaning Urban Institute, 99 percent of those removed from Medicaid will immediately qualify for other types of health coverage, including other taxpayer-funded coverage.
There's a lot of work to be done to restore our Medicaid program as a true safety net, but resuming redeterminations is a great and important first step. And ultimately, despite what you might be reading in the Arkansas news, these efforts to restore some integrity to the Medicaid program are cause for relief, not alarm.
This article is Part 1 in a new series of articles on the importance of Medicaid redeterminations and program integrity. To view other stories in this series, simply click the #ReclaimARSafetyNet hashtag below.