balance on a rough patch of earth at the edge of the carport. “All of my weight went on my right big toe, and I broke my toe,” she recalled. “And when that happened, my body swung around and my mouth hit the post that holds the carport up and knocked one of my front teeth out. It was horrible.” A dentist prescribed antibiotics to stave off an infection, and shortly thereafter, Brakebill attempted to fill it. “I was in Memphis for work and my mouth was hurt really bad,” she said. “I get to Walgreens and I find out they
LOCKED OUT: After Kyla Brakebill lost Arkansas Works coverage last September, she was unable to get treatment for multiple sclerosis.
won’t fill my prescription because my insurance had ended.” Baffled, she called Blue Cross and DHS as soon as she returned home. “After a million phone calls and finally getting to talk to someone, they said it was because I didn’t send a change of address.” Brakebill had recently lost her home to a foreclosure and had moved several times. However, she had filled out a change of address form at the post office and had her mail forwarded to a P.O. box. She had no idea, she said, that DHS required beneficiaries to directly notify the agency of any physical address change. And because her insurance was provided through Blue Cross rather than directly through the state — a feature born of Arkansas’s unusual privatized approach to Medicaid expansion — she wasn’t used to communicating with DHS about her coverage. “I never had another conversation with DHS about insurance after that initial application,” she said. DHS requires beneficiaries to notify it of any address change within 10 days of a move, agency spokeswoman Amy Webb said. If mail sent to a beneficiary
is returned to DHS and the agency hasn’t received notification of an address change, it will close that person’s case. ***
Though such coverage would likely The fact that Arkansas’s 18-month cost more than Arkansas Works (which decline in Medicaid enrollment outcosts little to nothing for beneficiaries), paced most other states also suggests more people moving up the income lad- there’s more at play than economic facder would be clearly positive news. tors. Arkansas’s unemployment rate is “I would emphasize that this is not a low, but so are those of other states change in services,” Hutchinson said at that haven’t seen a similarly steep dip a recent session with the press at which in Medicaid rolls. And while Medicaid he touted savings in the Medicaid budget. enrollment has fallen fairly steadily from “This is simply the result of people that January 2017 to June 2018, the unemare working. … If they got a better job and ployment rate over that period ticked they just don’t bother telling us about it, slightly upward, from 3.7 percent to 3.8 and they no longer qualify, that’s a good percent. The Arkansas jobless rate in thing, because nobody’s losing services. June ranked 21st in the nation, according It’s just that they no longer qualify and to the federal Bureau of Labor Statistics. we’re not wasting our taxpayers’ money. In July, DHS released a graph breakIf it’s because their spouse got insurance ing down the reasons behind the approxand they no longer need Arkansas Works, imately 14,000 Arkansas Works case then that’s a good thing as well.” closures the previous month. Only 11 Jennifer Wagner, a senior policy ana- percent of the cases closed in June were lyst at the Center for Budget and Policy attributed to an increase in household Priorities, a liberal-leaning think tank in income. However, Wagner said that figWashington, D.C., said the picture was ure likely understates the percentage of more complicated. people who left the program because of “I’m sure some portion is attribut- rising wages. Many beneficiaries who able to the improving economy,” Wag- no longer need Arkansas Works may ner said. “The thing that we tend to see, simply stop corresponding with DHS, though, is that even when people are rather than contacting the agency to able to find employment, often their explicitly request closure. income does not go up high enough to The governor’s second explanamake them no longer eligible. And often tion for the reduced enrollment is an the low-wage work they get does not improved effort at DHS to “scrub” the include health insurance. As we know, Medicaid rolls by removing people who a lot of people on Medicaid are work- are no longer eligible. That includes ing families — they’re just not making many situations: individuals who are enough [money] and they’re not get- making too much money, who have ting employer-sponsored insurance. So, moved out of state, who are incarcerI wouldn’t assume that all drop-off is ated, who have turned 65 (and are therebecause of that.” fore receiving Medicare) or who are
Over the past 18 months, Arkansas Works enrollment decreased by almost 60,000 people, DHS numbers show. Enrollment peaked near 330,000 sometime in January 2017. By July 1 of this year, it had fallen to 271,000 — a 15 percent drop. The state is shedding beneficiaries at a faster rate than any other state that chose to expand Medicaid, according to data from the federal Centers for Medicare and Medicaid Services. Arkansas saw a 6 percent decline in its overall Medicaid enrollment between January 2017 and May 2018. The shrinking Arkansas Works program evidently accounted for most of the drop. (The CMS data combines the expansion population and the larger, more expensive “traditional” Medicaid population, which includes children on ARKids, elderly people, disabled people and other groups.) Only three non-expansion states — Texas, Idaho and Tennessee — saw a larger percentage decrease in Medicaid overall. Arkansas has lately come under national scrutiny for its new work requirement for some Arkansas Works enrollees, with many health researchers and advocates warning the policy could lead to thousands losing coverage. Yet little attention has been paid to the steady monthly reduction SOURCE: ARKANSAS DEPARTMENT OF HUMAN SERVICES in Medicaid enrollment figures predating the work requirement, which began in June. The work rule won’t trigger terminations of coverage until September at the earliest. That means the almost 60,000 people pared from Arkansas Works over the last year and a half dropped away for other reasons. Governor Hutchinson has given two explanations. The first is a strong economy. Because Medicaid expansion is open only to those whose incomes fall below 138 percent of the federal poverty line (in 2018, that’s $16,753 for an individual or $34,638 for a family of four), getting a better job often makes a beneficiary ineligible for Arkansas Works. He or she might then gain insurance through an CHURN: In June, DHS closed 14,140 Arkansas Works cases for various reasons. Many of employer — or, if that’s not an those individuals have likely reapplied for coverage and will re-enter the program. DHS option, purchase a plan on the provided the above chart in a July report on work requirements. individual marketplace with the help of a federal subsidy.
arktimes.com AUGUST 9, 2018
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