LITTLE ROCK — Gov. Asa Hutchinson announced last month that the state Department of Human Services had eliminated a backlog of responses from Medicaid recipients trying to verify their eligibility, but the elimination of the backlog has not meant quick resolution for all cases.

LITTLE ROCK — Gov. Asa Hutchinson announced last month that the state Department of Human Services had eliminated a backlog of responses from Medicaid recipients trying to verify their eligibility, but the elimination of the backlog has not meant quick resolution for all cases.


That’s the lesson learned by Carol McClain of Barling, who has been trying since June to convince DHS that she remains eligible for the Medicaid expansion program known as the private option, so far without success.


"I’m falling through the cracks, I guess," she said.


McClain said she received a notice from DHS in June stating that she had to provide verification of her income and prove she remained eligible or her coverage would be terminated. She said she promptly provided a statement to the DHS office in Fort Smith soon showing she remains eligible — she is disabled and unable to work — but her coverage was terminated July 31 anyway.


It isn’t hard to guess why McClain’s coverage may have been terminated. At the time, the agency’s enrollment and eligibility system was automatically terminating coverage for anyone whose response to a re-determination notice was not received and opened within 10 days — but the agency was so overwhelmed with responses that it had a backlog of unopened mail.


On Aug. 4, Hutchinson ordered a two-week halt to terminations so DHS could catch up. On Aug. 18, he announced that the agency’s backlog had been eliminated and terminations would resume.


The elimination of the backlog seemed like good news for McClain — yet she still has not been reinstated.


How can that be? DHS spokeswoman Amy Webb explained that eliminating the backlog just meant catching up on opening the mail.


"Initially the backlog that we were talking about was the backlog of unopened mail, which we discovered was resulting in some people who had responded to our request for information getting their coverage cut off even though they had responded," she said.


Catching up on the mail "was just the first step in the process," Webb said. "What we do is open the mail, we scan it in, someone goes in and then clicks a task button that says ‘OK, don’t close this case, they’ve sent their stuff in.’ But that’s just the beginning of the process. Then there has to be manual casework to begin to process that information that was sent in, look at it, check it up against the data we had, and work any case issues that come up."


The agency began sending verification notices in mid-June, which means McClain must have been among the first to receive one. The agency has terminated coverage for 60,237 people, the vast majority of them because the agency did not receive and open a response from them within the 10-day deadline. It has reinstated 6,549.


McClain re-submitted her information in August after her coverage was terminated. Did that cause her to lose her place in line, so to speak? Webb could not comment on a specific case but said it may be possible that a second submission could trigger a new opening date for a case.


When Hutchinson announced that the DHS backlog had been eliminated, he also announced that two insurers in the private option had agreed to extend pharmacy benefits for 30 days to private-option participants whose coverage was canceled. But McClain’s 30 days are up, and she needs medications for multiple conditions including diabetes, neuropathy degenerative heart disease and high cholesterol.


"All my medications are $100 plus," she said.


Webb said people who believe they are eligible for reinstatement and urgently need medication should let DHS know about their situation.


"We are prioritizing those cases. If they have (an urgent medical) issue, they need to call and let us know," she said.


DHS is seeking to verify the eligibility of about 600,000 Medicaid recipients, including more than 200,000 on the private option, which began providing coverage in January 2014. Despite the large number of newly insured people in the state whose eligibility would have to be verified, DHS did not request funding for any additional positions in its budget this year.


"What we had hoped was the (computerized enrollment and eligibility) system would be where we expected it to be and it would provide much more automation than it did," Webb said. "In hindsight we do think we could have managed it better, but there were also a lot of changes that came down from the federal government. The software did not operate as promised, so that required a lot of customization. So a lot of things happened at once that delayed us."


She noted that a number of steps have been taken to speed the process, including hiring temporary workers, shifting employees within the agency and authorizing overtime pay so employees can work nights and weekends.


The problems with the process have been "a learning experience," Webb said.


"We understand people have been frustrated. We’re frustrated too. But were dedicated to making it better and getting it done," she said.


On Aug. 28, DHS announced it would extend the deadline to respond to re-determination notices from 10 days to 30 days, at the direction of the federal government, and that it would temporarily stop sending verification notices so it could update them to reflect the new deadline. The notices are still on pause.


That change came too late to help people like McClain. She said she knows she is not alone — and she was told as much when she contacted her former insurance carrier.


"They said there were thousands of people in the same boat as me," she said.