LITTLE ROCK — Steve Simmons of Fort Smith was shocked when he learned last week that his health insurance under Arkansas’ private option had been terminated, even though he had done everything that was asked of him to show that he remains eligible for the program.

LITTLE ROCK — Steve Simmons of Fort Smith was shocked when he learned last week that his health insurance under Arkansas’ private option had been terminated, even though he had done everything that was asked of him to show that he remains eligible for the program.


"I can’t get my B12 shot unless I pay for it," said Simmons, who has Sjogren’s syndrome, an immune system disorder. "My other medications are due to be refilled in 2½ to three weeks. I can’t refill them if I don’t have insurance by then."


Simmons is one of an unknown number of Arkansans who have been kicked out of the private option and other Medicaid programs for seemingly no reason as the state struggles through an eligibility verification process that officials admit has overwhelmed them.


The state Department of Human Services is seeking to verify the eligibility of about 600,000 Medicaid recipients by Oct. 1, as required by state and federal laws. The scope of the task has been expanded by the private option, which since January 2014 has used federal Medicaid money to subsidize private health insurance for more than 200,000 people earning up to 138 percent of the federal poverty level.


DHS canceled coverage at the end of July for 35,668 people, and about 13,000 more are slated for termination at the end of this month. The agency says about 97 percent of the terminations were triggered by failure to respond within 10 days to a notice requiring verification of income level.


Gov. Asa Hutchinson said Tuesday he was ordering a two-week moratorium on terminations because DHS was dealing with an "information overload" and said there was "anecdotal information" suggesting that some eligible people’s coverage had been wrongly terminated.


‘I Did Everything’


Simmons said he received a notice from DHS on June 27 advising him that he had to provide income verification within 10 days — not from the day he received the notice, but from June 24, the day it was issued — or his coverage under the private option would be terminated.


A full-time caregiver for his aunt, Simmons has no income. After numerous failed attempts to get through to someone at DHS, he got in touch with an official who told him to provide a statement about his lack of income to the Sebastian County DHS office. He provided a notarized statement on June 29.


On July 16, Simmons received a notice that his coverage had been terminated. He said he contacted a worker at the county DHS office who assured him that everything would be fine.


On Monday, Simmons tried to get a prescription refilled at a Fort Smith pharmacy and was informed that his medical coverage had been terminated. He said he has been told by DHS that his coverage should be reinstated, but by Friday it had not been — and no one can tell him when it will be.


"I did everything I was asked," he said.


Hutchinson and DHS officials have said people who appeal a termination within 90 days and can show that they are still eligible will have their coverage reinstated retroactively. Simmons, whose medications cost $2,000 a month, said that doesn’t do him much good.


"That might help someone if they have doctor’s bills and can resubmit them, but for medication there is no retroactivity," he said. "If you can’t get them on your insurance, you have to either pay for them or go without."


‘This Is Keeping Me Alive’


Sylvia Classic of Conway said she received no notice before DHS canceled coverage for her and her husband under the private option and their 16-year-old son under ARKidsFirst. She said a pharmacy called Tuesday to say her insurance was not covering her medication, and Wednesday, she received a package containing three cancellation notices.


Classic has gone back to school, and her husband has been looking for work for some time. The family currently has no income, she said.


Classic also has Crohn’s disease, a chronic inflammatory condition of the gastrointestinal tract. She cannot take over-the-counter medication for her symptoms, not even painkillers, and her condition has required surgery in the past and likely will again. She said she is certain she did not miss an income verification notice from DHS.


"With Crohn’s disease, if there is any communication that comes to me from DHS or any other source that I know involves my coverage, I absolutely respond to it," she said. "I look for these things, because this is one of the most important parts of keeping me alive."


Classic said she has cancelled an appointment with her gastroenterologist because of the termination of her coverage, but she has enough medication on hand to last about a month and a half.


"I am hoping that within the next six weeks we can get this resolved," she said. "But I have friends who also have coverage through (the private option) and they are also saying, ‘I’ve gotten this too. I’ve gotten a letter that says I’m already cancelled and … I never got anything that said I need to renew or update or send in any other information.’"


Classic said some suspect deliberate sabotage by people in state government who oppose the private option, but she does not see a conspiracy. She said that from what she has learned, "it’s really a lack of resources."


"That’s something I can believe, because (the private option) is relatively new," she said.


‘They Can’t Get Their Heart Medication’


Bobby Bowen, an insurance agent in Augusta, said he has 10 customers whose coverage under the private option has been terminated, and all 10 are still eligible. He said seven of them told him they submitted income verification within the 10-day deadline but were terminated anyway.


The promise of reinstated, retroactive insurance is of questionable value to people who urgently need medication, Bowen said.


"Those are the people that can’t afford to pay a premium anyway, so therefore, they’re probably the same people that can’t pay a $200 prescription to get their heart medication either," he said.


‘I Have A Fiduciary Responsibility’


Hutchinson said Tuesday that 20 DHS employees have been assigned to eligibility verification, a hiring freeze on 35 positions at the agency has been lifted, staff resources have been reallocated to DHS offices with the heaviest workloads, and overtime has been authorized for the agency’s employees.


DHS spokeswoman Amy Webb said Friday the agency also has been authorized to hire temporary workers to help with the backlog, which she said the agency hopes to have eliminated by the end of the two-week moratorium on terminations. She did not know how many would be hired.


The agency also has begun sending verification notices in envelopes bearing the DHS logo and warnings that the notices are urgent, which was not done previously, she said.


Webb said the agency’s automated system matches its information about people’s income levels with the Department of Workforce Service’s information, and if the levels are more than 10 percent different, and at least one of the levels is outside of the eligibility requirements, then a notice is sent requiring verification of income within 10 days. If DWS has no information on the person, that also triggers a notice, she said.


DHS has been receiving about 6,300 calls a day, Webb said. She did not know how many people have complained of erroneous terminations.


The agency has no reason to believe that any termination notices were mailed without being preceded by verification notices, she said.


Webb acknowledged that the terminations may raise health concerns for some people.


"If it’s an emergency situation, they should let the county (DHS) officer know that, and they will work as quickly as they can to address it," she said.


On Friday, the Democratic House Caucus called on Hutchinson to extend the 10-day deadline for people to respond to income verification notices. He stood by the deadline.


"As governor, I have a fiduciary responsibility to the taxpayers to be a good steward of our state and federal dollars," he said.