JOHN YANG: Medicaid is America's largest single provider of health care coverage serving low income adults and children and people with disabilities.

In the early days of the pandemic, Congress temporarily block states from kicking people off Medicaid even if they were no longer eligible.

As a result, enrollment reached unprecedented numbers.

But that's ended and now states have until next year to go back to pre-pandemic rules.

Check if those on Medicaid are still eligible and remove those who aren't.

Ali Rogin recently traveled to Arkansas which is nearing the end of that process, which is known as unwinding.

WOMAN: Howdy.

JENNIFER ROSE, Medicaid Recipient: Hi ALI ROGIN: For Jennifer Rose and her wife Melanie reading Tarot cards is a way to spend time together other end make some money.

JENNIFER ROSE: It looks like there are some career possibilities that you might be thinking about.

ALI ROGIN: The couple regularly does readings around Fayetteville, Arkansas which they've called home for three years.

That's on top of Melanie's work as a massage therapist and astrology writer.

JENNIFER ROSE: And there you are the queen of wands.

ALI ROGIN: They've been on Medicaid since November 2020.

Both because of their combined income and Jennifer's disability brought on by rheumatoid arthritis and rare immune deficiency.

JENNIFER ROSE: I have two infusions each month, those are absolutely life-saving medications that are very, very expensive.

ALI ROGIN: The couple new Arkansas' Medicaid program was changing with the expiration of pandemic era protections, which meant people whose covered had been extended past their eligibility would lose it.

And even though Jennifer said their eligibility hadn't changed months earlier, they've been asked to prove it by sending in some additional paperwork.

Jennifer took no chances.

JENNIFER ROSE: I went in person to the office.

I made sure that it was turned in.

ALI ROGIN: When they hadn't heard anything.

A few weeks later, Jennifer went back to her local Department of Human Services.

JENNIFER ROSE: I was told by the person at the front desk that I was denied that my application had been denied.

I didn't even get a chance to you know, submit other paperwork or have a conversation with the caseworker like I'm completely and utterly confused.

ALI ROGIN: More than 230,000 Medicaid recipients in Arkansas have lost coverage since April.

About a quarter of them would have lost coverage anyway because they now earn too much money or asked to be removed.

But most were terminated for procedural reasons like failure to return renewable forms.

JENNIFER WAGNER, Center on Budget and Policy Priorities: We're very concerned when we see those numbers.

ALI ROGIN: Jennifer Wagner is a Medicaid Eligibility and Enrollment expert with the Center on Budget and Policy Priorities.

So far 34 states have publicly reported their unwinding data of those states Arkansas has one of the highest rates of ending Medicaid coverage because of paperwork issues.

JENNIFER WAGNER: Their rate of termination, their low rate of renewal is kind of out of whack with what we're seeing in other states, which is very concerning.

ALI ROGI: The Centers for Medicare and Medicaid Services recently warned Arkansas that its high paperwork termination rate might mean people are having trouble understanding and submitting Medicaid renewal forms and needlessly losing coverage as a result.

And while Arkansas termination rates seem high, Wagner says many states are having problems processing three years worth of Medicaid renewals.

In fact, the Centers for Medicare and Medicaid warned that over half the states in the country are kicking people off at to higher rate, and that all 50 states may be kicking children off disproportionately.

JENNIFER WAGNER: We're seeing metrics that we've never seen before, but we actually don't have a baseline.

This has not been measured and reported on before.

ALI ROGIN: In response to PBS News Weekend, a spokesman for Arkansas Department of Human Services said there were large numbers of beneficiaries who would have been disenrolled were it not for the pandemic error requirement, and that it is not surprising that this group would be disenrolled at a high rate now, experts have also noted that some people who were terminated for paperwork reasons may have also been otherwise ineligible.

MELISSA MCMANUS, Legal Aid of Arkansas: Mark your calendar to be on the lookout for your renewal timeframe ALI ROGIN: Just north of Fayetteville, Melissa McManus is an attorney with Legal Aid of Arkansas which provides free services to low income people.

She helped Jennifer rose with her case.

MELISSA MCMANUS: People are coming to us because they've been terminated and the people are eligible.

ALI ROGIN: Each Friday Legal Aid runs a help desk for Medicaid recipients at the local courthouse.

Some clients are getting requests to submit extra documents when they shouldn't be renewed automatically.

MELISSA MCMANUS: It's cumbersome upon these individuals to try and gather information that is outdated that they may not have real access to.

ALI ROGIN: The process has been particularly stressful for Arknasans originally from the Marshall Islands.

The Marshalese community in Northwest Arkansas is one of the nation's largest with more than 15,000 people because of a unique immigration agreement with the U.S., Marshallese people couldn't get on Medicaid until 2020.

Now they're having to reenroll for the first time and many have limited proficiency in English.

The state provides translations but some say they still can't understand the forms.

CARLNIS JERRY, Marshallese Educational Initiative: That people that translate here.

I'm not from here.

They're outside and they're not Marshallese.

ALI ROGIN: Carlnis Jerry is with the not for profit Marshallese Educational Initiative.

She spends most of her time these days helping her community navigate their Medicaid status.

CARLNIS JERRY: The first time they sent out the flyer, I couldn't understand what they were saying.

ALI ROGIN: How does that make you feel?

CARLNIS JERRY: I feel like we're here.

We took a step forward and then we took a lot of steps backwards.

ALI ROGIN: Arkansas Department of Human Services said it began outreach to the Marshallese and other communities more than a year before the unwinding began.

REP. ROBIN LUNDSTRUM SPRINGDALE, Arkansas House of Representative: Promotes integrity and the welfare programs.

ALI ROGIN: The federal government is giving states up to one year to complete the Medicaid unwinding process.

But in 2021, the Arkansas legislature passed a law cutting that back to six months.

JENNIFER WAGNER: There is an indicator shinned that they are going faster than they need to.

ALI ROGIN: Wagner says the shortened timeframe could lead to unintended consequences.

JENNIFER WAGNER: If there's a huge spike in application volume the next month or two, that suggests that a lot of people were in fact eligible and erroneously lost coverage.

REP. AARON PILKINGTON (R) Arkansas State Representative: A six month period is better than a year long period.

ALI ROGIN: Arkansas State Representative Aaron Pilkington voted for the shortened timeframe.

AARON PILKINGTON: The longer we allow people to remain on these roles who do not qualify, who do not need it, that's taking money out of the hands of those who are truly needy.

ALI ROGIN: Many people who are having trouble reenrolling have been told simply to reapply for Medicaid.

And that is going to add its own backlog.

AARON PILKINGTON: That's a fair criticism.

I would argue though, if you're doing what you need to do, if for some reason you are excellent kicked off, it's nice to know that there is a way to get back on.

If you were worried about your coverage, we had made notices we had done, you know, try to let people know about it.

ALI ROGIN: Some of the public awareness efforts don't reach Arkansans living in rural areas.

Many of them are low income and change addresses frequently or don't have steady access to the internet.

Oftentimes, their first chance to address their Medicaid status is through their provider.

Clinics like Boston Mountain Rural Health played a critical role in ensuring those patients keep their coverage.

Sayde Davis helps patients navigate their Medicaid status.

SAYDE DAVIS, Boston Mountain Rural Health: There's a lack of knowledge and a lot of our patients about how to go about a lot of these things.

They're getting information in the mail that maybe they don't understand.

ALI ROGIN: Boston Mountain has offered patients help with insurance for several years.

But they've had to hire even more staff to help with the unwinding.

Beth Harris runs clinical operations here.

BETH HARRIS, Boston Mountain Rural Health: And we're constantly expanding that program as the need continues to arise.

I do expect it to increase just based off of what we've seen previously in the past.

ALI ROGIN: Back in Fayetteville, Jennifer Rose got back on Medicaid about as quickly as she got kicked off.

JENNIFER ROSE: I really just picked up the phone and there they said we've made a mistake and your Medicaid is fine.

And I said okay, thank you and they hung up.

That was it.

MELISSA MCMANUS: And you got that notice and writing.

ALI ROGIN: But she says she was only able to sort things out with the help of legal aid and Melissa McManus.

MELISSA MCMANUS: I love my job I help.

I love helping people.

But it would give me great pleasure if they didn't need me.

You should need a lawyer to be able to keep your health insurance.

ALI ROGIN: Until then she'll be at the courthouse every Friday to help.

For PBS News Weekend, I'm Ali Rogin in Fayetteville, Arkansas.