MM Curator summary
Arkansas Medicaid members are not getting vaccinated, but its not as bad the number based on submitted claims for vaccinations.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
VAXXED: A patient receives a COVID shot at UAMS clinic (file photo) Brian Chilson
At a press briefing yesterday, Governor Hutchinson announced the state will begin increasing the amount it pays doctors and other medical providers who vaccinate Medicaid beneficiaries against COVID, from $40 per shot to $100. The reason, the governor said, is that vaccination rates among recipients of traditional Medicaid are very low:
In fact, only 27,000 traditional Medicaid clients age 12 and up have been vaccinated. Now, to put that in perspective, we have 627,000 recipients on traditional Medicaid [who are 12 and up]. That means that 4.3% of traditional Medicaid recipients are vaccinated. That is extremely, extremely low, and a very vulnerable and at-risk population, and it’s a challenge for us.
Increasing the reimbursement rate for shots may be a good idea. It’s one of several ways Hutchinson is trying to increase immunizations in under-vaccinated Arkansas, where hospital ICUs are brimming with COVID patients. But the tiny numbers he gave for vaccine uptake were likely a big undercount.
It turns out the state has received 27,000 claims for COVID shots for Medicaid recipients, according to the Arkansas Department of Human Services. (DHS is the state agency that administers Medicaid.) A claim is the request for payment that a doctor submits to Medicaid or other insurer after providing a medical service. It’s almost certain that many thousands more people on Medicaid — especially nursing home residents — have actually received shots.
“We don’t have a specific number in terms of clients who have ‘gotten vaccinated.’ We can tell you how many vaccination claims have been billed, and that was the 27,000 number the Governor mentioned yesterday,” DHS spokeswoman Amy Webb wrote in an email.
Medicaid, a joint state-federal program, provides insurance to over a million Arkansans, or roughly one in every three people in the state. As of June, the “traditional Medicaid” program referenced by Hutchinson included about 450,000 children on ARKids and about 266,000 adults, who are generally disabled and/or elderly.
(In addition to traditional Medicaid, there’s also “Medicaid expansion,” which covers another 321,000 beneficiaries who are low-income, non-disabled, working-age adults. Medicaid was “expanded” to cover this population under the Affordable Care Act, former President Obama’s health care reform package; in Arkansas, Medicaid expansion is called Arkansas Works. The governor was not including this group in the numbers he gave yesterday.)
The 4% figure stated by Hutchinson was surprising in part because it seems at odds with the high rate of vaccinations reported among nursing home residents. Federal agency data indicates something like 80% of nursing home residents in Arkansas have been vaccinated against COVID, and an industry group representing nursing homes has reported similar numbers. How could that be, considering about two-thirds of all nursing home residents in Arkansas are on traditional Medicaid?
Apparently, many Medicaid beneficiaries in nursing homes have gotten COVID shots that don’t show up in the state’s Medicaid billing system. That’s because most nursing home residents are also on Medicare, the federal health insurance program for the elderly. For thousands of so-called “dual eligible” beneficiaries, Medicaid pays for the cost of a nursing home (or “long term care,” in the parlance of health care), but Medicare pays for most other medical costs, such as hospital stays, doctor visits — and vaccinations.
“Medicaid is the payor of last resort, so they probably would bill Medicare first,” Webb said in a phone call. “That’s why they wouldn’t show up [in the Medicaid claims.]”
DHS is working on getting a more precise figure that takes into account dual eligible people and other factors, Webb said. “To be clear, we still think the numbers are low based on what we have now,” she wrote.
It’s also likely that others have gotten vaccinated without showing up in the Medicaid billing system. Though COVID shots are free to all patients, regardless of whether they have insurance, doctors and other medical providers usually ask for insurance information so that they can get reimbursed afterwards. But if a person doesn’t have that information, they’ll usually be given the shot anyway.
“We know that clients could have gotten any vaccination site and not shown their card,” Webb wrote. “We also know that providers have a while to bill so there could be vaccines we don’t know about yet. Either way, the billed number is still low, which is why we are changing the rate.”
Hutchinson said yesterday he hopes boosting the reimbursement from $40 to $100 will incentivize doctors and other providers to “engage with the beneficiaries on the vaccines and to answer questions, consult with them at length and to encourage vaccinations.”