Governor gives two-week moratorium on Medicaid verification so DHS can catch up, but no relief for those already harmed | Arkansas Blog

Tuesday, August 4, 2015

Governor gives two-week moratorium on Medicaid verification so DHS can catch up, but no relief for those already harmed

Posted By and on Tue, Aug 4, 2015 at 1:53 PM

click to enlarge RELIEF ONLY TEMPORARY: Gov Hutchinson with DHS Director John Selig announces a two-week moratorium, but no permanent change — or help for people already punished — in the 10-day time period to respond to a check on income eligibility for Medicaid.
  • RELIEF ONLY TEMPORARY: Gov Hutchinson with DHS Director John Selig announces a two-week moratorium, but no permanent change — or help for people already punished — in the 10-day time period to respond to a check on income eligibility for Medicaid.

Early reports from Gov. Asa Hutchinson's news conference say that he has announced a two-week moratorium of the 10-day prove-it-or-lose-it income verification window for the private option and other Medicaid health insurance coverage. But he made it clear he's not backing away from the 10-day window nor giving any relief to those already caught up in the problem, perhaps through no fault of their own. Benji Hardy reports from the scene below.

Hutchinson said he wants to allow the Department of Human Services time to catch up, so terminations will be halted for two weeks.

It tends to put the lie to DHS protestations that they have been on top of the situation. That's not what we've been hearing from multiple sources, both people covered by the private option and insurance people working with them to keep their insurance in place. For example, today, from an insurance industry executive who says people were dropped last weekend despite compliance with requirement to supply information showing they were still eligible:

I have one client, one of the 13 I can prove we sent information in on in plenty of time, who cannot get their prescriptions. Been without them for 24 hours. I have spoken with the highest officials about all the problems.

NOTE: DHS provides this information sheet about who to contact, for folks in need of information on this topic.

Some 50,000 Arkansans were set to be dropped from the roughly 250,000 who obtained coverage for failure to respond to letters about potential changes in income. See this link for the story of why this has been much harder than it might sound. The mailings aren't clearly identified. Making contact with DHS has been hard. People are out of pocket, especially during the summer, or may have moved.

And, finally, sometimes the process still doesn't get done by DHS, which is struggling to handle the volume of responses.

The same insurance executive said before today's announcement:

DHS, through Webb, said they are surprised and somewhat troubled 97% did not respond to notices. I have been saying for weeks they are responding, but DHS is backlogged and unable to process. In the same article, DHS said the call center is overworked and taking thousands of calls a day. They’re exploring many options to address the problem. But I guess they think it’s okay to not offer an extension while they continue to strategize and allow people’s coverage to be cancelled while they figure this out.

a. How can DHS say that 97% have not responded but they also admit they cannot even take phone calls? It is the phone number, by the way, the letter recipients are directed to call to ask for more time and have any questions answered. The first couple of weeks, your call was just dropped. Now, a standard recording says to go to local DHS office. Well, try calling them, too, and see what happens.

2. I have personally responded to 17 notices (many more of my clients responded on their own, these are just the one I personally sent in). Of the 17 I personally helped, 14 were cancelled on Saturday. Yes, 14 were cancelled and do not have any insurance. 55 of my clients were cancelled on Saturday, total. The story DHS continues to stick to is laughable. These people indeed are responding, DHS is just not processing. They do not have the training and manpower get close to meeting the deadline these Medicaid recipients are directed to follow.

3. Reinstatement via appeal is absurd. The disruption in coverage – not being able to fill medications, see providers without paying upfront with money they do not have, etc. – will be catastrophic for many. The neglected care will only be part of the problem, as DHS still will have to find the time to manually process these appeals. How can they process an appeal if they cannot even process proof of income?

4. The original redetermination plan – set to begin in late September of 2014 – gave the program recipients 90 days to get their information and case renewed. And they were going to do this on a rolling basis. The timeline was compressed to 10 days from 90, and the number of renewals increased exponentially due to the backlog. I mean, this is absolutely insane. 

Huchinson apparently is giving some relief. A better solution would be extension of the time period on a permanent basis.

UPDATE FROM BENJI AT THE NEWS CONFERENCE:

Hutchinson said he's not adjusting the 10 day window, but he will institute a two-week moratorium on terminating people's insurance while DHS deals with a processing backlog.

"The challenge is not the 10 day notice requirement. The challenge is processing the information whenever the beneficiary sends in the information," he said.

The governor said he's authorizing additional resources for DHS to deal with the increased workload, including lifting a hiring freeze on 35 positions, reassigning additional employees and allowing overtime.

Crucially, though, for the tens of thousands of people whose private option insurance has already ceased, the terminations that have already been sent out will still stand.

DHS spokesperson Amy Webb said after the press conference that about 35,000 Medicaid recipients received letters in July and have had their coverage end this month. Not all of those are private option recipients; some receive other benefits, such as AR Kids insurance. Webb said about 13,000 additional termination letters have gone out this month.

Reporters pressed Hutchinson on the question of what would happen to former beneficiaries who have unexpectedly had their coverage cancelled after not replying to the termination notification within the 10-day window — or if they've attempted to reply but have been lost in the backlog.

Those individuals have a 90 days to challenge the termination and, if they are successful, would have their insurance retroactively reinstated, Hutchinson said. He admitted that there has been "anecdotal information" that some people may have received notices despite being eligible — in other words, that the verification system has proved fallible, to put it generously.

But when asked what patients should do if their benefits unexpectedly evaporated, he only said they should submit their pay stubs and go through the process of getting reinstated.

"We've got to process that and hopefully that will be a very short amount of time," he said.

Hutchinson defended the 10 day window as reasonable. "The federal government determined that it should be a minimum of a 10 day notice ... I believe they determined it was adequate," he said. After the conference, JR Davis, a spokesperson for the governor, said that time period was established by the Beebe administration as part of the original plan for the private option.

The governor emphasized the importance of performing income verifications, saying that ineligible recipients would cost the state "a significant amount of money."

"I would suspect that with 250,000 [individuals] on the private option, if overall we determine that 21,000 are ineligible to remain on the private option, that reduction results in over $10 million in savings. That's per month," he stated.

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