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In some states, about half of those whose Medicaid renewal cases were decided in April or May have lost their coverage, according to data submitted to the Centers for Medicare & Medicaid Services and obtained by The Associated Press. The primary cause is what CMS describes as “procedural reasons,� such as the failure to return forms.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,� Health and Human Services Secretary Secretary Xavier Becerra wrote in a letter Monday to governors.

Instead of immediately dropping people who haven't responded by a deadline, federal officials are encouraging state Medicaid agencies to delay procedural terminations for one month while conducting additional targeted outreach to Medicaid recipients. Among other things, they're also encouraging states to allow providers of managed health care plans to help people submit Medicaid renewal forms.

Nobody "should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,� Becerra said in a statement.

States are moving at different paces to conduct Medicaid eligibility determinations. Some haven't dropped anyone from their rolls yet while others already have removed tens of thousands of people.

Among 18 states that reported preliminary data to CMS, about 45% of those whose renewals were due in April kept their Medicaid coverage, about 31% lost coverage and about 24% were still being processed. Of those that lost coverage, 4-out-of-5 were for procedural reasons, according to the U.S. Department of Health and Human Services.

In Arkansas, Florida, Idaho, New Hampshire and Oklahoma, about half or more of those whose eligibility cases were completed in April or May lost their Medicaid coverage, according data reviewed by the AP. Those figures may appear high because some states frontloaded the process, starting with people already deemed unlikely to remain eligible.

CMS officials have specifically highlighted concerns about Arkansas, which has dropped well over 100,000 Medicaid recipients, mostly for not returning renewal forms or requested information.

Arkansas officials said they are following a timeline under a 2021 law that requires the state to complete its redeterminations within six months of the end of the public health emergency. They said Medicaid recipients receive multiple notices — as well as texts, emails and phone calls, when possible — before being dropped. Some people probably don't respond because they know they are no longer eligible, the state Department of Human Services said.

Republican Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s redetermination process, saying Arkansas is merely getting the program back to its pre-pandemic coverage intentions.

But health care advocates said it's particularly concerning when states have large numbers of people removed from Medicaid for not responding to re-enrollment notices.

"People who are procedurally disenrolled often are not going to realize they’ve lost coverage until they show up for a medical appointment or they go to fill their prescription and are told you no longer have insurance coverage,� said Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families.

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Associated Press writer Andrew DeMillo contributed from Little Rock, Arkansas.