More Medicaid mess at DHS 

Calls daily about loss of coverage.

click to enlarge YOUTH HOME

People on Medicaid — including ARKids patients, private option patients or people on original Medicaid — are again having problems getting coverage because of state computer problems.

The Department of Human Services knows there's a problem, but can't estimate its magnitude, spokesperson Amy Webb said.

The Arkansas Times first contacted DHS in March to ask about problems with ARKids enrollees losing coverage. Since then, however, the Times has learned that the problem is not just with ARKids patients, but Medicaid-insured people in general. Though she couldn't say how many people are affected, Webb did say that calls from people having trouble with coverage have been coming in daily since the Times first contacted her.

Webb confirmed that the problem lies in the agency's computer system where eligibility data is input. She said software was sometimes not properly transferring data to the Medicaid Management Information System that health care providers use to check on patients' insurance, but that the agency's technicians haven't been able to uncover the flaw.

Problems in the eligibility system can stem from inaccurate data coming from the federal program, casework errors or system errors, Webb said.

"There are a lot of people who are getting the care they need; the system is working for them," Webb said, noting there are around 1 million people in the state's Medicaid system. But she says the agency is aware that people are having problems and are frustrated.

The problems are not just the transfer of data to the MMIS system, Webb says, but the system's "functionality" in its ability to handle federal and state eligibility rules.

"We have put in some additional measures to try to mitigate it until we can fix any system issues," Webb said. Gov. Hutchinson has directed DHS to pause in the development of the eligibility system until the state works out its Medicaid reforms. Once the reforms are in place, a request for proposals for a "system integrator" will be issued, Webb said.

Peggy Kelly the clinical director at Youth Home, a Little Rock mental and behavioral health provider where adolescents are treated in both in- and out-patient settings. Kelly called the insurance situation "dire" in early April. It's better now, she said; Youth Home is now seeing a "steady pace" of activations and deactivations. There are 18 or 19 outpatients that Youth Home can't see because they've lost coverage, Kelly said, and around five inpatients. For now, Youth Home is covering the inpatient costs, with the expectation that the facility will be reimbursed.

One of Kelly's biggest concerns is that adolescents with mental illness cannot fill their prescriptions.

Ricky King, a father of two children who were issued Medicaid cards in August, said that's his eldest daughter's situation. She was prescribed two psychotropic medicines, but pharmacies say she's not covered. He said Medicaid covered one month at Youth Home but not the following months, and that there is no way he can pay the bill.

King said his daughter "dwindled off" the drugs, and has had no bad reaction yet.

King said he was recently informed by Youth Home that DHS has said the problem with her coverage was that she had no Social Security number on file. But that was just an excuse, King said: "They [DHS] wouldn't have issued me a card if I didn't give them a Social Security number."

King, who said he has called DHS almost weekly since January and who has also called the governor's office, said he continues to be told her information is not being recognized by the Medicaid management system. "If you talk to DHS, they say she's insured, but if you talk to her doctors, they say no," King said. "I just pray nothing happens that she doesn't get hurt."

King's younger daughter, meanwhile, has had no trouble getting covered when she's been to the doctor, he said.

Mena resident Ricky Bagwell called the Times in April to say he'd mailed three renewal forms to DHS for his son, who was at Youth Home, and when he got no verification of enrollment, went in March in person to fill out new paperwork at the DHS office in Mena. A month later, he said, he tried to check on his son's coverage, but was told at the Mena office that they didn't have access to the data. Youth Home, however, told him his child was not covered.

At DHS spokesperson Webb's request, this reporter provided Bagwell's information to her. "It was a miracle," Bagwell said last week. Almost immediately after Webb received the information, "[DHS] called me and told me at first that they had everything and were going to send me a form to fill out. An hour later they called back and said, 'We've got everything we need, your son has insurance.' ... . It was very weird." He said the insurance was also upgraded from ARKids B, which requires a copay, to ARKids A, which does not.

Because of new requirements in the Affordable Care Act, all enrollees in ARKids had to re-enroll by March 30 this year and had to provide tax information for the first time. Because of the change — re-enrollment previously was done on a 12-month basis — DHS put notices out about the change starting in mid-2015 and distributed flyers in English and Spanish to libraries, childcare centers, Arkansas Advocates for Children and Families, the state Health Department and other agencies. It also created radio ads, informed legislators and included information in the agency's Connect Care newsletter that goes to all families. The agency sent a third and final mailing in January, this time to 42,000 families that had not renewed.

Webb said DHS anticipated there would be some glitches because of the new re-enrollment deadline and at one point predicted that 100,000 children covered under the program would lose their insurance. In April, DHS put the final number at 54,116, Webb said. It's not known if that includes families now having trouble getting coverage who believed they were insured.


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