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What would happen if a citizen of Cash, Ark., lost Medicaid benefits? Nothing good.

Cash, Ark., is home to Brad Ledgerwood, a 40-year-old who was born with cerebral palsy. He has received Medicaid insurance since he turned 18 to help manage his life at home in a wheelchair. “I can do everything I want to do as far as my mind,” he said. He has been on Cash’s city council for nine years. “My problem is my physical ability,” he said. “I cannot do anything physical by myself. My mom and dad are my hands and feet.”

Brandon Dill/For The Washington Post

Medicaid insurance helps Brad Ledgerwood, who was born with cerebral palsy, remain at his home in Cash, Ark. (Brandon Dill for The Washington Post)

Brandon Dill for The Washington Post

Brandon Dill for The Washington Post

Ledgerwood's mother, Ann Ledgerwood, quit her job as a county appraiser to be his caretaker. Medicaid covers the cost of eight hours of care a day. (Brandon Dill for The Washington Post)

As many as 16 million low-income Americans, including millions of children, are destined to fall off Medicaid when the nation’s federal public health emergency ends and extra funding to the states stops — a process dubbed “unwinding.” Because of a computer error, Ledgerwood started receiving notices in November that he would fall off the eligible recipient list, though his benefits haven’t been turned off yet because of the emergency. He has been fighting the error with an attorney’s help.

Ledgerwood describes Cash as a “spot in the road.” (Brandon Dill for The Washington Post)

Candace Cook leads her horses along Arkansas Highway 226 in Craighead County outside of Cash. (Brandon Dill for The Washington Post)

Birds fly over Cache River Valley Seed in Cash. (Brandon Dill for The Washington Post)

Brandon Dill/For The Washington Post

Brandon Dill/For The Washington Post

Cash used to be a center for the lumber industry but is now primarily a farming community. (Brandon Dill for The Washington Post)

A child plays with a virtual reality headset. (Brandon Dill for The Washington Post)

Vacant buildings dot Main Street in Cash, which sits in the Arkansas Delta. (Brandon Dill for The Washington Post)

Because the state has continued Medicaid eligibility reviews through the pandemic, health officials in Arkansas found that more than 220,000 people no longer qualify but still receive benefits. Starting this month, a nonprofit working with the state will start trying to call people to check their phone numbers and addresses so that renewal notices — once they are sent out — will reach them. Time is crucial. Arkansas passed a law last year that requires the state to carry out its Medicaid eligibility decisions within six months of when the unwinding begins — half the time the Biden administration says states should take.

“I know how to fight it,” says Ledgerwood, who was recently appointed to a Medicaid consumer advisory board that Arkansas is creating. What he worries about, he says, “is people who don’t know to call a lawyer and don’t know their rights.” (Brandon Dill for The Washington Post)

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