Thousands of the most vulnerable Medicaid beneficiaries will not be protected by state's deal with insurance companies | Arkansas Blog

Tuesday, August 18, 2015

Thousands of the most vulnerable Medicaid beneficiaries will not be protected by state's deal with insurance companies

Posted By on Tue, Aug 18, 2015 at 2:52 PM

HUTCHINSON: Offered no plan today for the most vulnerable beneficiaries now facing a gap in coverage.
  • HUTCHINSON: Offered no plan today for the most vulnerable beneficiaries now facing a gap in coverage.
As we reported this morningBlue Cross Blue Shield and Centene (which sells as Ambetter in Arkansas) will reinstate pharmacy coverage for private option beneficiaries whose coverage was terminated via the state's troubled eligibility verification system. That is undoubtedly good news: people in Blue Cross and Centene private option plans will at least be able to get needed medication even if DHS terminated their coverage. 

Unfortunately, that provides no help for other beneficiaries, including some of the most vulnerable: private option beneficiaries deemed "medically frail" and routed to the traditional Medicaid program — as well as other Medicaid beneficiaries who aren't on the private option at all, including kids and very poor parents. 

The deal with the insurance companies and the state (see details here) guarantees pharmacy coverage for those with Blue Cross and Centene plans who lost coverage on August 1 (it is not yet clear whether the deal will continue into September for those losing coverage September 1, but it most likely will). A third carrier, QualChoice, declined to participate, so those beneficiaries will get no relief from the deal. 

QualChoice has a smaller market share than Blue Cross and Centene, which led Gov. Asa Hutchinson to say today that the "overwhelming majority" of those who lose coverage were Blue Cross and Centene beneficiaries. That may well be true, but among those left without help: not just those with QualChoice, but thousands of those covered by traditional Medicaid. And the people covered by traditional Medicaid are those that we should be most worried about if there is a gap in coverage.

As part of private option policy, around ten percent of beneficiaries who gained coverage as part of Medicaid expansion are routed to the traditional Medicaid program because they were found to have greater medical needs according to a health screener that is part of the application process. These are the "medically frail" — the folks most in need of medical care. Unfortunately, they will not be helped at all by this deal with Blue Cross and Centene, and now face gaps in coverage that make it impossible for them to access care or get vital medication. 

Meanwhile, some people were in "old Medicaid" — the program that existed even before Medicaid expansion. That would include extremely low-income parents of dependent children (families who make less than 17 percent of the federal poverty level) and children on ARKids.

What kind of numbers are we talking about? We know that 35,668 Medicaid recipients had coverage terminated on August 1. Of those 31,501 were beneficiaries from the Medicaid expansion (or private option, as we usually call it). That means around 4,000 are beneficiaries from the old Medicaid program (again, that's children in ARKids or very low-income parents). They get no relief from this new deal and still face all of the potentially dire consequences of gaps in coverage. 

Meanwhile, some subset of the 31,501 were routed to the traditional Medicaid program instead of the private option. because they were medically needy. How many? DHS doesn't know, that wasn't tracked in the data. But we know that ten percent of the overall private option population is "medically frail." If we guesstimate that ten percent of the cancellations were medically frail as well, that amounts to a little more than 3,000 people. 

So even with this deal, there is a real risk that 3,000 of the beneficiaries most at risk if there are gaps in coverage are still out of luck this month. And another 4,000 beneficiaries of the old Medicaid program who are also among the most vulnerable (most likely children and extremely poor parents) are also facing a crisis this month. That's potentially around 7,000 (perhaps a bit less, perhaps a bit more) of the most at-risk beneficiaries. The situation for them is just as dire today as it was last week.  

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