We’ve been writing a lot about Arkansas’s efforts to clean up our Medicaid rolls, and for good reason: Arkansas is leading the nation with the most aggressive clean-up initiative in the country and Medicaid now consumes more than a third of all state spending. We also have Medicaid waiting lists with intellectually and developmentally disabled individuals waiting for services. So, to put it mildly, this issue deserves serious attention.

Earlier this week, the Arkansas Department of Human Services released their first monthly unwinding report that details how many ineligible people were removed from Medicaid in April, and why.

DHS identified there are three categories of individuals who were removed for paperwork-related issues:

1. ‍Those who failed to return a renewal form (35,625 enrollees or 93.8 percent);
2. ‍Those who failed to return requested information (7,673 enrollees or 4.2 percent); and ‍
3. Those whom DHS was unable to locate and resulted in “returned mail” (739 enrollees or 1.9 percent).

Now if you simply read local news coverage or hysterical tweets, you would think that these categories were all the same. In fact, you would think that all 54,411 individuals in the “extended” category (i.e. those who were ineligible at initial review but had coverage extended due to the COVID-19 public health emergency) were removed for failing to return paperwork or having their paperwork lost in the mail.

I hope you’re sitting down while you’re reading this, because I have to let you in on a secret: this is untrue. These are separate and distinct categories that mean different things.

And in reality, the vast majority of those losing coverage for “paperwork” reasons aren’t because of “bad addresses,” lost mail, or confusing paperwork. It’s because enrollees did not care enough about their benefits to return their paperwork at all.

‍

The vast majority of enrollees who were removed for “paperwork” reasons chose not to return anything

DHS’s first category, comprised of individuals who “failed to return renewal form,” is the largest at 35,625 enrollees, or 94 percent of the removed extended enrollees.

According to DHS, these are individuals whose eligibility could not be confirmed through internal data matching. In other words, DHS tried to keep them on the rolls, consistent with their unwinding plan, but could not do so with the data they were able to obtain.

So, what did DHS do? They sent all of these individuals pre-populated forms that already included significant portions of the enrollees’ personal information on it. That is to say, DHS filled out the forms for the enrollees.

And then they did something truly crazy (insert tongue into cheek): they sent these prefilled forms out and asked enrollees to confirm the information, sign the forms, and send them back.

These are not individuals who had bad addresses. In some cases, DHS may have asked for some additional information beyond what they had on hand. But at most, all those enrollees had to do was provide minimal information, sign the form, and return it. That’s it.

We can all speculate about why so many chose not to do that; undoubtedly, many of them had obtained other coverage by going back to work and no longer needed or wanted the benefits. But to suggest that these enrollees were somehow bamboozled, not given a fair shake to prove their eligibility, or otherwise caught in a “paperwork” snare is ludicrous.‍

‍

An additional segment of enrollees chose not to return requested information‍

DHS removed an additional 1,596 enrollees (4.2 percent) from the Medicaid rolls for failing to return all of the necessary information to renew their coverage. These individuals received the DHS notices and returned the paperwork, but the information was incomplete.

As noted by their unwinding plan, DHS spent a significant amount of time reaching out to these enrollees to obtain the missing information but was unable to get it.

This can occur for a variety of reasons. Perhaps enrollees know they no longer qualify and decided not to provide all of the requested information. Perhaps it was simply an oversight and they still qualify, in which case they can re-enroll in the program at any point.

But to call this a paperwork or mail snafu seems disingenuous.‍

‍

Less than two percent of removed extended enrollees had returned mail‍

Finally, there were 739 extended enrollees who were removed from the program because DHS could not locate them. This is less than two percent of all of the individuals who were removed for “paperwork issues.”

Less than two percent.

It’s worth noting that this is an incredibly low number in relation to the size of the Medicaid program, which now has more than 1.1 million enrollees. The fact that DHS was able to locate so many enrollees is frankly impressive.

But what about those 739? What happened to them?

Well, we obviously cannot say for sure, but there are a variety of reasons why DHS might not be able to locate an enrollee:

• They moved out of state;
• They never lived in the state to begin with;
• They never existed (i.e. identity theft; we have seen this problem and the problem above in our Medicaid program before); or
• They passed away.

But again, to say that these people – or anywhere close to a significant number of enrollees – were ensnared by “paperwork” is inaccurate. The vast, vast majority of enrollees have been located, contacted, and given sufficient opportunities to complete their renewals.‍

‍

Bottom line: Enrollees bear responsibility for proving their eligibility‍

The taxpayers of Arkansas are spending gobs and gobs of money not only paying for the Medicaid program, but hiring extra staff, financing advertising campaigns, paying for mailers, and a whole host of other things to help Medicaid enrollees renew their coverage if they qualify. But at the end of the day, Medicaid enrollees also bear some responsibility to prove their own eligibility. If they cannot even be bothered to return even a pre-populated form, they must not value their highly-generous Medicaid benefits.

There are a variety of reasons Arkansans are leaving the Medicaid program right now. Some of them are obvious, some of them are not. But to suggest that it’s due to a “paperwork maze” or an epidemic of lost mail is far from reality.‍

‍

This article is Part 3 in a series on the importance of Medicaid redeterminations and program integrity. To view other stories in this series, simply click the #ReclaimARSafetyNet hashtag below.