At a time when most states are reviewing the eligibility of their Medicaid beneficiaries over the course of one year, Arkansas decided to review all beneficiaries in only six months. This process is known as Medicaid renewals and it could cause people to lose coverage, even if they are eligible. In Arkansas, a large number of people are losing their Medicaid coverage rapidly — sometimes before they are aware of it. The data from the end of July show just that; since April, Arkansas has disenrolled over 260,000 from its Medicaid rolls, 202,000 of those disenrollments have been for procedural reasons; typically, procedural disenrollments occur when renewal packets were not turned in on time or the state has outdated information on an enrollee. High procedural disenrollments are concerning for a state because a majority of beneficiaries disenrolled for paperwork reasons are still eligible for Medicaid coverage.
Nearly half of all health center patients are impacted by the expedited timeline, making Community Health Centers critical players in keeping patients throughout the state covered. We spoke with two health centers in Arkansas about how they quickly operationalized renewal efforts.
Boston Mountain Rural Health Center and Expanding the Assister Workforce
Boston Mountain Rural Health Center (BMRHC) serves around 24,000 patients across north central and central Arkansas. We spoke with Beth Harris, Chief Clinical Operations Officer, and Sayde Davis, Behavioral Health Director to learn about BMRHC’s response strategy to the quick transition.
When BMRHC learned about Medicaid renewals, the health center immediately began training and expanding their staff, namely their In-Person Assister (IPA) team, for the onslaught of patients cut from coverage during renewals. IPAs, also known as insurance assisters, play an important role within health centers; they help new and existing patients navigate state Medicaid applications or the federal health insurance marketplace to enroll in high-quality and affordable health coverage.
IPAs at BMRHC work closely with the front office staff at multiple sites to identify patients who have been disenrolled from Arkansas’s Medicaid program. The patients can meet with IPAs when they show up for appointments and receive help with renewal applications. IPAs have noticed a lot of patients with challenges accessing the technology required to complete their renewal and assist them onsite at the health center.
Harris said their biggest pain point with renewals has been “making sure there are enough boots on the ground for the patients.” In response to this challenge, the health center nearly doubled their IPA workforce of eight to 14, recognizing assisters are one of the largest resources for patients.
As an added boost, BMRHC is training additional health center employees to carry out IPA services, which made Harris and Davis quite proud and exemplifies the commitment of health centers to underserved communities.
“Our employees really just dig in and say, we’re going to do whatever we need to do to take care of our patients,” said Harris. “As a health center anytime that something potentially threatens us to not be able to take care of our patients [it] sends us all relaying, into preparation mode. That’s something I was very proud of, that we decided to invest in more of our employees and equip them to better [support] our patients.”
Due to Arkansas’s quick renewal timeframe, Community Health Centers like BMRHC are stepping up and working to the top of their capacity in order to ensure their patients and community members don’t become uninsured. It is important that patients are knowledgeable about completing their renewal forms to have their Medicaid renewed or transition to the health insurance marketplace in a timely manner. The targeted training and education of BMRHC staff and IPAs has allowed patients to feel confident about navigating the process to keep their coverage. IPAs conduct direct outreach to patients, letting them know exactly what they need to bring to the Department of Human Services (DHS) office or to submit their information online.
“It is creating predictability for the patient, and I think that helps them to have more confidence in us”
Mid-Delta Health System and the Importance of Internal Workflow & Communication
Mid-Delta Health Systems is a small health center that provides primary care, dental and behavioral health services to around 3,500 patients at three clinics in east central Arkansas. Susan Caplener, Outreach & Patient Services Coordinator works hard to ensure patients visiting Mid-Delta clinics are aware of Medicaid renewals and how the health center can help.
When renewals began, Susan immediately swung into action.
“Even though it was on the news, and there were commercials, there were billboards around here, there were still a lot of people that just didn’t quite understand what was going to happen,” she said.
She aligned her efforts at Mid-Delta with the state’s health department. Whenever they would post something about Medicaid renewals, Susan shared it on the health center’s Facebook page. Flyers were made available at each clinic’s front desk with key messages for patients: update your contact information, check your mail regularly, and turn in your renewal packet to the health department as soon as you can.
When we met with Susan, Arkansas was four months into the unwinding and Mid-Delta noticed many patients still coming in for their appointments unaware their Medicaid coverage had been terminated. When this happens, front desk staff, providers, and even the health center’s billing department alert Susan works as a one-woman team helping patients with their renewals and whether their disenrollment from Medicaid was for procedural reasons.
Face time is essential. Susan reminds patients to not only to check their mail for renewal information, but to bring their mail to the health center so she can help them respond and complete and submit necessary information. Susan also knows her way around the local DHS office, a critical advantage during renewals. After she helps a patient with a renewal form or application, she can email it to her DHS colleague directly. Susan’s ability to do this gives peace of mind to both her and Mid-Delta patients, knowing their information was received by the right office in a timely manner.
“Right now, we’re just doing the best we can do. The best thing for them [the patients] is for me to catch them when they’re in here [the clinic], and we can get that application filled out,” she explained, noting that she could use some help but is grateful to have such a strong internal operation that is responsive to the growing need for insurance assistance. “It’s going to get better,” she added optimistically.
Nationally, some 7.1 million Americans have lost their Medicaid coverage, according to an analysis by the Kaiser Family Foundation.