MATTHEW MOORE: A new report from Arkansas Advocates for Children and Families shows that the uninsured rate for children in the state is the highest it’s been in a decade. Camille Richoux is the health policy director for the organization. She says one of the leading contributors to this issue is that children who are eligible for state-funded health care, like Medicaid or CHIP, are getting kicked off their coverage despite still being eligible.
CAMILLE RICHOUX: But due to paperwork, moving, or administrative error, they lose coverage for a period of time. These are just fluctuations in health coverage that a lot of people experience. This is a very expensive issue in health care. It is expensive on the administrative side because you’re having to re-enroll people who should have never lost coverage. That takes time. It takes money. And it also can be at best inconvenient for families and at worst catastrophic, because even short gaps in coverage can become a crisis when an emergency happens and you go to an ER where you find out you don’t have coverage or your child doesn’t have coverage, or you go in to fill a prescription that you need to stay healthy and you can’t fill it because it’s suddenly hundreds of dollars. So what that means is lost days of school, lost days of work for families who have parents who are losing coverage. That squeezes family finances even harder and can be really terrible in the case of an emergency health situation.
MOORE: One piece of data that I found really fascinating is that northwest Arkansas, the 3rd Congressional District, has the highest child uninsured rate in the state at more than 10 percent. And that’s nearly double any other district in Arkansas. What do you think it is specifically about northwest Arkansas in this region that shows why this gap is so wide?
RICHOUX: I think that data point is really surprising to folks, especially those in northwest Arkansas, that think those kinds of issues don’t exist here, that northwest Arkansas is very prosperous, which is true. But there are huge disparities in coverage even within counties. So part of that which the data kind of breaks down by race, by income, by household language and other things like that. And Arkansas's data shows that Latino and Hispanic kids are less likely to have coverage. There were huge losses in coverage, particularly, the data shows Asian American Pacific Islander for northwest Arkansas. That would primarily be your Marshallese community. These families and households were hit very hard during the unwinding. So, um, that was whenever the continuous protections of the Covid nineteen pandemic. So nobody lost Medicaid coverage during that time when the state began its redetermination process? There were zip codes we looked at where, you know, tons of Marshallese kids who were still eligible, by all accounts,were losing coverage. Their household incomes weren’t changing, but due to administrative issues, mistranslations, and not enough outreach to these communities that they were seeing high losses in coverage.
So I think there’s a combination of the makeup of northwest Arkansas, who is falling through the cracks, who we’re not doing enough outreach to, and who the state needs to do more to reach to make sure these kids are covered. There’s also—this data doesn’t show it, but looking forward to the future with the recent HR 1, or the One Big Beautiful Bill passed—I am kind of worried about the ways that bill is going to make those disparities in coverage in that district even wider.
MOORE: This going well into my next question. One of the big takeaways from this data is that foreign-born children in low-income households are five times more likely to be uninsured than their peers. Nearly 20 percent of kids in non-English-speaking households lack coverage. Language clearly seems to be one of the barriers for this. But what other barriers, unforeseen or unexpected, are keeping these kids who are eligible for insurance from getting the resources that they are eligible for?
RICHOUX: When you look at determinants of health, the ways you can predict whether kids stay insured or lose insurance, you’re looking at kids and families at the margins. One of the most common things we see is housing insecurity. If you’re in a family that, because you’re lower income, you have to move more frequently—even if you’ve updated your address, sometimes it doesn’t get updated in the system. So letters for renewals are going back to the wrong address.
During the unwinding, we saw some cases of people who moved due to domestic violence situations who lost coverage because they were moving around or staying in shelters. We did some work in some homeless shelters where we interviewed people, and nearly everybody had lost coverage at some point because they had no housing, no address to send a letter to. And so, when we’re thinking about the kids losing coverage, it’s kids who already have some of the odds stacked against them, who are already needing extra care and extra supports, who are falling through the cracks and we're not capturing enough. And again, these are kids eligible for health coverage through ARKids First. It is important we do everything we can to make sure they’re not losing coverage.
MOORE: Uninsurance among women of childbearing age remains a major health risk, and a substantial percentage of people in Arkansas who are of childbearing age don’t have insurance or aren’t properly insured. In a state like Arkansas, where it feels like every time I come on the radio we’re talking about maternal health and maternal mortality, this just seems to be another indicator that we have room to grow in elevating our maternal health statistics.
RICHOUX: I’m very encouraged by some of the work that was done during the legislative session around maternal health. We had some great wins around increasing doula coverage and more investments in maternal health. But Arkansas continues to have one of the highest maternal mortality rates in the country. There is this reality that pregnancy and childbirth don’t exist in a vacuum. Your health before you become pregnant, your health care access as well, goes into what happens during your pregnancy. If you have elevated blood pressure or insulin resistance, that doesn’t just go away while you’re pregnant. Those can exacerbate issues. You get gestational diabetes. The highest drivers of maternal death in Arkansas are cardiovascular issues.
When I think about the data showing higher rates of uninsurance for women before they become pregnant, we need to make sure people get preventative care before they decide to get pregnant and have children. And then there’s that care piece—Arkansas is the only state that still hasn’t taken steps to extend postpartum Medicaid coverage. There are still thousands of women after they give birth—60 days after—who are completely losing health coverage, losing access to screenings, postpartum depression care, or ongoing chronic condition care. There’s still so much work to be done. This report is sort of reminding us that we’ve made some progress. We've made some progress but the bottom line is we need to keep working.
MOORE: The data is important because it helps to give you a framework of how to think about shaping policy, right? Without good objective data, it's hard to know where we need to make improvements, where we can make changes. Much of the work that you do is policy work. Much of the work you do is looking at the data and deciding what policies would help us. So what's the answer to that question? What policies would help us with these main issues we're seeing from the data here?
RICHOUX: Well since we just talked about maternal health, obviously Advocates has been at the forefront of encouraging the state to do what nearly every other state in the U.S. has taken steps toward—adopt 12-month postpartum Medicaid coverage. It is evidence-based, common sense, good policy and good politics. As for kids and families falling through the gaps, we would encourage increased outreach and enrollment support, especially among families and communities hit hardest by churn and coverage losses. That includes lower income families, families who speak English as a second language and need extra support, and rural Arkansans who live far from their local DHS offices or lack broadband access, since Arkansas ranks near the bottom in the country for high-speed internet access.
There are so other ways. Whenever you’re eligible for Medicaid, your household is likely eligible for other programs like SNAP, TANF potentially, or WIC. We also have very low WIC enrollment, and WIC is an incredible program that helps babies and moms with nutrition and lactation support, all these wraparound services. We encourage them to take advantage of the Medicaid application process, to connect and enroll eligible families in other programs to make it easier for people to get enrolled in the services they're eligible for and to stay enrolled in them.
All of these things are shown to support health and economic stability. The enrollment and eligibility information we’re seeing shows not enough families who are eligible in services are enrolled in them.
MOORE: Camille Richoux is the health policy director for Arkansas Advocates for Children and Families. We spoke over Zoom last week. You can find a copy of the report on their website.
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