February 9, 2018

Division of Medical Services Office of Policy Development
P.O. Box 1437 (Slot S295)
Little Rock, Arkansas 72203-1437

RE: Medical Services Policy Manual Sections A-210, B-500, D-372, and D-373 (Retroactive Medicaid Eligibility)

To Whom It May Concern:

Disability Rights Arkansas, Inc. (DRA) is the federally authorized and funded nonprofit organization serving as the Protection & Advocacy System for individuals with disabilities in Arkansas. DRA is authorized to advocate for and protect human, civil, and legal rights of all Arkansans with disabilities consistent with federal and state law. I am writing on behalf of DRA to submit this letter with our comments on the proposed change to retroactive Medicaid eligibility from ninety (90) days prior to date of application to thirty (30) days prior. DRA is not in favor of this change.

A reduction in the retroactive eligibility period accomplishes nothing but increasing the financial burden on those who are already struggling with expensive and unforeseen medical emergencies. Additionally, it increases the financial burden on healthcare providers and the state by increasing the amount of uncompensated medical care costs in the state. Healthcare costs are already a significant driver of debt and bankruptcy, both in this state and nationwide, and it makes little sense to roll back protections meant to protect disadvantaged Arkansans.

There are ways to mitigate the potential damage caused by this change, such as an effective presumptive eligibility system. In 2016, when Arkansas last sought approval to eliminate retroactive eligibility, one aspect of the conditional approval was the implementation of a presumptive eligibility system. Presumptive eligibility would allow the state to enable qualified entities to make an immediate temporary eligibility decision, which would greatly streamline the determination process. Currently, presumptive eligibility is only used for pregnant women in Arkansas.

Another problem with the reduction of retroactive eligibility is that it is yet another change to the Medicaid system in Arkansas. Since the creation of Arkansas Works in 2014, there have been significant changes to the program every year. The elimination of retroactive eligibility is only one of several pending waiver amendments for the upcoming year. The confusion caused by keeping this program in permanent flux is bad not only for consumers, but for the providers, and will lead to breaks in coverage and increased administrative costs.

While DRA understands that the state is concerned with making the best use of their Medicaid dollars, we feel that there are better ways to accomplish this goal than shortening the retroactive eligibility period. DRA appreciates the opportunity to provide these comments, and we hope that the State will carefully consider our position and recommendations.


Tom Masseau
Executive Director