More than 427,000 Arkansas residents were dropped from Medicaid in the past six months, as the state became among the first nationally to complete a post-pandemic eligibility review of the government-funded health care program for lower-income residents.

The state ended coverage for more than half of those whose cases were reviewed during the period — a removal rate that raised concerns Tuesday among some health care advocates even as the Republican-led administration defended its efficiency in shrinking the Medicaid rolls.

"Arkansas has distinguished itself by moving very rapidly to kick families off coverage, regardless of whether they are still eligible," said Joan Alker, executive director of the Georgetown University Center for Children and Families.

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During the coronavirus pandemic, states were prohibited from removing people from Medicaid in exchange for receiving enhanced federal funding. That moratorium ended in April, and states were required to resume annual eligibility reviews for participants. During the freeze, Medicaid enrollment swelled by nearly one-third nationally, from 71 million people in February 2020 to 94 million in April 2023.

States have 14 months to finish their backlog of eligibility reviews, according to guidelines from the federal Centers for Medicare and Medicaid Services. But a 2021 Arkansas law required the state to complete the task in six months.

Arkansas Department of Human Services Secretary Kristi Putnam said she was proud of the staff's speedy work "to ensure that our program is serving only those who truly need Medicaid."

"I’m excited to finally put the pandemic and the special rules that had been in place behind us, so we can focus on serving Arkansans under normal eligibility operations going forward," Putnam said in a statement Monday.

Republican Gov. Sarah Huckabee Sanders’ administration has continually defended the state's review process — which renewed coverage for about 298,000 people during the past six months — even as some national groups have cited the state as a negative example.

Like in most states, many of those who lost Medicaid coverage in Arkansas were removed for procedural reasons, such as not returning renewal forms needed to verify their eligibility. Health care advocates contend some of those people likely would have remained eligible if the state had their full information.

People removed from Medicaid can regain coverage retroactively if they provide information proving their eligibility within 90 days.

But Arkansas Democratic Party Chairman Grant Tennille said the disenrollments would have consequences even for people who are later able to regain coverage.

"It’s not just an inconvenience," Tennille said at a news conference on Tuesday. "It can delay or terminate necessary medical procedures. These are people’s lives that we’re gambling with."

House Minority Leader Tippi McCullough, a Democrat, said Arkansas residents are being robbed of stable health care coverage as they are dropped from Medicaid.

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"How can you look at these numbers and not think the system has failed Arkansas families?" McCullough said.

While Arkansas forged ahead with eligibility reviews during recent months, some other states paused procedural terminations and slowed down their review process as federal officials raised concerns. President Joe Biden's administration said last month that 29 states and the District of Columbia had acknowledged automation errors that flagged entire households as potentially ineligible instead of reviewing each person individually. Children typically have higher income eligibility thresholds than adults, causing federal officials to raise concerns that some may have been needlessly dropped from the rolls.

Arkansas officials have said they didn't experience those automation problems, But figures provided by the state indicate around 149,000 children were removed from Medicaid during the past six months.

Arkansas' percentage decline in children covered by Medicaid ranks among the largest in the nation, Alker said.