For Healthy Pregnancies, Arkansas Should Streamline Medicaid Eligibility

With an ongoing backlog in Medicaid applications over the past year, tens of thousands of Arkansans have waited longer than the maximum time allowed under federal law for approval of their health coverage.

They’re families like Jessica Lewis and Frank Wood of Fayetteville, who are expecting their first baby this summer. Jessica waited more than four months for her pregnancy Medicaid application to be determined one way or the other, and she kept getting turned away from providers while her application was pending. She didn’t have her first prenatal appointment until she was already 6 months pregnant.

At one point, a women’s health clinic that is a Medicaid provider told the couple they had to pay a $1,000 deposit to receive prenatal services while their Medicaid application was pending. They didn’t have that kind of money, so they delayed care until they found a provider that didn’t have such a requirement.

It doesn’t have to be this way. If Arkansas adopted a policy called “presumptive eligibility” for pregnancy coverage in Medicaid, expectant moms like Jessica could be approved quickly based on their income level. Right now, mothers who are eligible for Medicaid are waiting months to get coverage – longer than is allowed under federal law – even though it’s abundantly clear that prenatal care is essential to both infant and maternal health.

There’s no defending that long wait, especially when a presumptive eligibility policy would be an easy fix for it. Twenty-nine states and the District of Columbia already do this. It’s one of several policy changes we strongly recommend now that almost all abortions are illegal in Arkansas. If we want babies born healthy, we need to make sure parents have access to prenatal care.

A Dangerously Long Wait

For now, Jessica and Frank are relieved to have received the medical care they needed, if late in the pregnancy. They first applied for Medicaid in January and finally heard in late May that Jessica’s pregnancy Medicaid was approved.

Federal law requires that Medicaid applications be determined “promptly and without delay.” State agencies must process most applications within 45 days (they have longer, 90 days, to determine eligibility for those applying on the basis of disability). But many Arkansas applications were pending well beyond that requirement over the past year.

During the first half of this year, applicants waited an average of 70 days to have their applications approved.

At the height of the backlog, Arkansas Department of Human Services reported that more than 23,000 new Medicaid applications were pending past the 45-day limit – some far beyond that. Now, DHS reports that the number is under 1,000. Late last year, state lawmakers approved spending more than $50 million to hire contractors to help the agency catch up. DHS officials said that the main cause of the backlog has been staff turnover, with the added complication last year of office closures and staff quarantines when COVID-19 cases were more widespread.

This backlog has affected not only people waiting for health care services like Frank and Jessica, but also doctors, clinics, nursing homes and hospitals that may be providing care to Medicaid applicants without reimbursement for long periods of time.

A Huge Challenge Is Looming

One added reason for concern about the staff shortages and delays is that DHS will soon have to redetermine eligibility for everyone covered by Medicaid. When the federal Public Health Emergency ends, DHS is required by state law to redetermine eligibility within six months for all 1.1 million Arkansans who have Medicaid-funded health coverage or are part of the Children’s Health Insurance Program. That includes children on ARKids First, seniors in nursing homes, people with disabilities, those with private insurance coverage funded through the ARHome program, and more.

One of the key aspects of the Public Health Emergency – first declared in March 2020 – was that no one could lose their existing Medicaid coverage, regardless of changes in their circumstances, while the emergency declaration is in place. It remains in place, at least until mid-October. When it does end, federal policy would allow the state to redetermine eligibility for those enrolled in Medicaid within 14 months of the Public Health Emergency’s end. But a state law passed in 2021 requires the state to do so within 6 months.

Thankfully, Arkansas has been checking eligibility for those currently on Medicaid throughout the pandemic. As of February, they had a list of 300,000 people who may not be able to keep their coverage when the Public Health Emergency ends, and they’re already reaching out to them to ensure that all their information is updated before the redeterminations begin.

If you have Medicaid coverage, we urge you to update your contact information to make sure DHS has all the information needed to redetermine your eligibility. You can learn more about how to do that at this website. There’s a hotline to update your information at 1-844-872-2660.

This is complicated work, and it takes experienced staff to make it happen. In light of existing shortages that led to the application backlog, we urge the Arkansas Legislature to consider spending some of the state’s record $1.6 billion budget surplus to ensure that DHS has the eligibility workers it needs and can pay them well enough to compete in this labor market.

In the meantime, with presumptive eligibility, we can at least ensure that expectant mothers have the coverage they need, and quickly.