Friday, August 28, 2015

State going to 30-day window for health insurance verification

Posted By on Fri, Aug 28, 2015 at 9:50 AM

click to enlarge NOW THEY RELENT: Gov. Hutchinson and DHS Director John Selig forced by feds to give up 10-day response window on Medicaid eligibility verification.
  • NOW THEY RELENT: Gov. Hutchinson and DHS Director John Selig forced by feds to give up 10-day response window on Medicaid eligibility verification.
Under pressure from the federal government, the state of Arkansas is relenting on its 10-day window for replying to notices that those with private option health insurance must provide verification of income for eligibility. The period will increase to 30 days.

Gov. Asa Hutchinson — who'd hewed strongly to the shorter limit despite extensive reporting about problems in the notification process, an overwhelmed staff and the likelihood that tens of thousands of eligible people would be tossed off the program — will have a statement later, his office said.

However ... this new procedure provides only in the future. It does not, a Department of Human Services spokesman said, apply to the 58,000 or so who either lost their coverage at the beginning of this month or have been notified of coming loss of coverage for failure to respond to the verification checks. "CMS did not ask us to do this retroactively, and we do not have a way to do that," Amy Webb of DHS said.

DHS said: 

Last year and in subsequent conference calls, the Centers for Medicare and Medicaid Services (CMS) approved Arkansas’s approach to redeterminations, which included a process that gave clients 10 days to submit requested income documentation. CMS has changed its guidance, and as a result, future redeterminations will now include 30 days to submit documentation.

The Department of Human Services will temporarily stop sending re-determination notices so that the notices can be updated to reflect the new timeline, coded into our system and tested to ensure they go out as expected. The change will apply to clients who have not yet received a re-determination letter and to those who received a letter but have not yet had their cases closed or renewed (these individuals will receive a second notice explaining that the timeline to respond has been extended).

In regard to those clients whose cases have already been processed, federal law gives people who have received a closure notice 90 days from the date of closure to provide income verification and have their coverage re-instated without going through the application process again.

Due to the changing federal guidance and the impact it could have on our timeline to initiative renewals, CMS offered to extend the state’s deadline to process renewals. Arkansas plans to accept that offer.

Questions had been raised by the Times and others about whether the state's process was legal. The feds themselves had questions, as this e-mail DHS released also indicates and the state seems to finally acknowledge that today.

From: Cash, Judith (CMS/CMCS)
Sent: Thursday, August 27, 2015 9:18 PM
To: Dawn Stehle (Dawn.Stehle@dhs.arkansas.gov)
Cc: Costello, Anne Marie (CMS/CMCS); Delone, Sarah (CMS/CMCS)
Subject: Medicaid Renewals

Hi Dawn.

As we discussed, federal regulations at 42 CFR 435.916(a)(3) require that, at annual redetermination, if the state is unable to renew coverage based on available information, the state must give beneficiaries 30 days to complete a pre-populated renewal form, which the beneficiary can complete and return online, by phone, by mail or in person, in order to provide the state with information needed to determine continued eligibility. The state informed CMS late last year that is was using Change-in-Circumstances functionality to process renewals as a temporary mitigation and has been giving individuals 10-20 days to provide information. In addition, due to systems limitations, that state had the authority, based on an approved 1902(e)(14) waiver, to delay annual renewals and has just recently begun that process.

Per 42 CFR 435.916(a)(2), the state should continue to renew, via an ex parte process, the coverage for individuals whose continued eligibility can be determined using existing data sources. For all others, as a temporary mitigation strategy, until the state has developed required capacity to send prepopulated renewal forms, the state should revise its renewal notices, explaining the information needed from the beneficiary to determine eligibility, and give the beneficiary at least 30 days to respond with the required information.

If the state would like to request an extension of the 1902(e)(14) waiver, to allow additional time to process renewals and give beneficiaries adequate time to respond and confirm their continued eligibility, CMS would entertain such a request. Please let us know if you have any questions.

Judith


Judith A. Cash
Director
Division of Eligibility and Enrollment
Children and Adult Health Programs Group
CMCS/CMS

This development will add to ongoing legal research into a potential lawsuit for all those facing cancellation from imposition of the 10-day response time when federal rules allowed a longer period. A lawsuit continues on shortcomings in the state's initial income verification process filed this week by Legal Aid of Arkansas.

UPDATE FROM BENJI:

Wait, so how many people actually have lost their insurance coverage at this point? That's a surprisingly tricky question, even after consulting with DHS.

So far, DHS figures show 58,895 have received termination notices to date. These people either (1) had their coverage end at the beginning of August or (2) are about to see their coverage end in a few days, at the beginning of September (or for some, the beginning of October).

Out of those 58,895, there are 2,306 people who have actually been determined ineligible. Those people are gone, out of the system, and presumably for good reason — DHS has found that they are no longer eligible for the private option or other Medicaid. Maybe they make too much money. Maybe they moved out of state. Maybe they died.

The remaining 56,589 — the vast majority — have been kicked off of insurance, or are about to be kicked off, because they "failed to provide verification." (Note that this is hardly the sole fault of the beneficiary, considering the problems that have plagued the entire re-verification process; anecdotally, there are people who made every effort to respond on time and still were kicked off.) Anyone who lost insurance for failure to provide verification has a 90-day reinstatement window to provide DHS with the information needed to prove that they are actually income-eligible.

DHS said today that 3,286 beneficiaries have been reinstated. Those are people who have provided income information within the 90-day reinstatement window, and DHS has since restored their insurance.

In other words, that leaves 53,303 who are actually either without insurance or soon will be without insurance. But their situations vary widely as well. 

Most of those people have pharma coverage now, thankfully. Private option beneficiaries with plans through Blue Cross or Ambetter can still get their prescriptions; whether they can see a doctor depends on the provider. The majority of the 53,303 who lost insurance (or soon will lose it) were covered through one of those two carriers.

But others do not: Beneficiaries with QualChoice plans (the smallest carrier in the state) have no such luck on a pharma plan. And those covered by traditional Medicaid programs — which are likely to be among the neediest beneficiaries, including patients with chronic conditions, ARKids recipients and very low-income parents — are also simply without insurance at the moment, pharma or otherwise.

And it's difficult to determine how many people are losing coverage in a few days, on Sept. 1. Some 35,000 30,000 were terminated at the beginning of August (some of those, I assume, are among the 3,286 who have been reinstated to date). Many of the remaining number are going to lose their coverage at the beginning of September. However, due to another wrinkle in DHS policy, people who received letters in the last ten days of August won't see their coverage terminated til the beginning of the next month, so October 1.

To sum up: Thousands of eligible people have partial coverage right now — thanks to Blue Cross and Ambetter — but are still waiting for their full insurance to be restored. Thousands of other eligible people simply have no coverage at all. And thousands more are slated to lose it soon, either in a few days or in a month.

The new 30-day response window will make it much more likely that tens of thousands more won't be thrown into the same gap, because they'll now have more time to respond to DHS' request for information before being slated for termination.

UPDATE: The Arkansas Citizens First Congress expressed "relief" that DHS had fixed "one of the worst parts of the policy, but expressed dismay  that they are not applying it retroactively to more than 50,000 families who’ve lost coverage under the old process."

Mark Robertson, co-chair of the grassroots group, said "it is an unacceptable double standard to cancel the insurance of over 50,000 Arkansans who were caught up in a process that even the state now acknowledges was flawed and unfair.” He noted that the state could allow 90 days, rather than just 30, to verify income. He said people have received inaccurate information, endured long lines and still had sudden terminations.


“This is a partial step in the right direction but we need need a comprehensive fix that’s fair to everyone, including those who have already been cut off,” Robertson said. 

Robertson says Arkansas DHS needs to immediately reinstate everyone they’ve dropped and give them all the same 30 day opportunity to comply. They need to dramatically improve outreach to families who are often elderly, disabled or impoverished. And they need to pick a fair policy they can be consistent with instead of having change every week with consumers and DHS employees confused across the state about what the rules are.

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