The Medicaid mess: More than 25,000 beneficiaries (including ARKids children and the medically frail) still don't have coverage for medication | Arkansas Blog

Monday, August 31, 2015

The Medicaid mess: More than 25,000 beneficiaries (including ARKids children and the medically frail) still don't have coverage for medication

Posted By on Mon, Aug 31, 2015 at 10:31 AM

click to enlarge HUTCHINSON: The governor said that the "overwhelming majority" of beneficiaries who had coverage terminated would be helped by deal with insurance companies, but that's not so.
  • HUTCHINSON: The governor said that the "overwhelming majority" of beneficiaries who had coverage terminated would be helped by deal with insurance companies, but that's not so.
As the Arkansas Medicaid verification mess continues, it's important to remember the stakes: tens of thousands of Arkansans, many or most of them actually eligible for the program, are now facing gaps in access to care. That includes more than 25,000 who won't even have access to medication while things get sorted out, including the most vulnerable patients — kids in ARKids, very poor parents, and the "medically frail." 

The feds, of course, have stepped in and finally forced Gov. Asa Hutchinson to move to a 30-day response deadline for Medicaid beneficiaries to respond to renewal-and-income-verification letters. 

However, that's only going forward. The state has no plans to reinstate or provide additional help to more than 50,000 beneficiaries who have lost coverage due to the unworkable and unreasonable 10-day policy, even though we now know that the old policy violated federal regulations. 

The Hutchinson administration has pointed to relief provided by Blue Cross Blue Shield and Centene (selling in Arkansas as Ambetter), two of the three insurance companies selling private option plans. The majority of those who have lost coverage are private option beneficiaries, which means that Medicaid purchases private plans for them. Blue Cross and Centene chose to unilaterally reinstate pharmacy coverage for beneficiaries who were covered by their plans but were terminated via the 10-day policy. That's very good news — it means that those beneficiaries will still be able to get needed medication (though they won't be immediately covered for non-pharmacy medical services; the details are complicated, see here). 

That good news applies to around 23,000 beneficiaries covered by Blue Cross who had their coverage terminated, as well as around 8,000 Ambetter beneficiaries. Together that amounts to a little more than half of the coverage terminations (not the "overwhelming majority," as Hutchinson previously stated). 

Unfortunately, however, around 8,000 beneficiaries who had their coverage terminated were covered by QualChoice, and QualChoice chose not to participate in the pharmacy coverage deal with the state. If those folks try to get their medication this month, they will be turned away.  

It gets worse. The bandaid fix by the insurance companies only covers beneficiaries on private plans. But there were tens of thousands more covered by the traditional Medicaid program, and they too will have no pharmacy coverage. Unfortunately, these are the state's most vulnerable beneficiaries: 

Around 8,000 of the "medically frail" had coverage terminated. Under the private option (the state's version of Medicaid expansion), most beneficiaries go to private plans, but around 10 percent of beneficiaries are deemed "medically frail" and routed to the traditional Medicaid program. These beneficiaries took a health screener during application and were found to have high medical needs. In other words, these are absolutely the last people you would want to see without coverage and without access to needed medication. 

Around 8,000 children on ARKids had coverage terminated. That's 8,000 kids who now do not have access to care, including needed medication. 

Around 3,300 extremely poor parents of dependent children had coverage terminated. Parents of dependent children who make less than 17 percent of the federal poverty level (a little more than $4,000 per year for a family of four) were eligible under the old Medicaid program, prior to expansion. They are still covered by the traditional Medicaid program rather than the private option. It is worth noting that almost all of the people in this group are likely still Medicaid eligible (see here for details). These are some of the state's poorest citizens, acting as caretakers for children, and the now do not have access to care. 


p.s. A note on these numbers: a small number of people in each category have either had coverage reinstated or have already been found ineligible (in cases where that data is available, I've subtracted from the approximations above). This mostly impacts the people on private plans (Blue Cross, Centene, QualChoice). In total, around 2,300 have been found no longer eligible and 3,400 have been reinstated.  

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