In the enormously disruptive process that is health care reform, some turbulence is unavoidable, but there’s a lot of room for improvement in how the Medicaid rolls are being brought up to date.

The requirements of the Affordable Care Act have meant that state agencies carrying out this program of health coverage for the poor need better information about their beneficiaries. For families with children, the state Department of Human Services had allowed "passive renewal," in which beneficiaries were automatically renewed unless they answered DHS queries with changes in family size or income that disqualified them.

Childless adults always had to actively renew enrollment, but at least for this year, DHS is requiring most of its beneficiaries to submit a form, supplying newly required information and updating what’s on file.

All recipients were notified by mail: first, an advanced warning of an enrollment packet on the way, then the forms themselves. There was a warning notice mailed if they failed to submit the forms.

Many people did fail to do so. The March mailing resulted in 11,600 residents being cut off from Medicaid, known in Hawaii as Med-QUEST or, more commonly, as Quest.

Obviously, there is enough blame to go around for this circumstance. Families receiving this entitlement bear responsibility for informing DHS about changes in address and status, as the law always required.

However, for many of them, routines keep changing, making maintenance of records difficult. Households with children became accustomed to the passive-renewal process that was long-established for them, so the recent change was unexpected.

Their mailing address can be an unreliable point of contact. Those who qualify for Medicaid are in low-income households, and some do not have stable living conditions, moving from place to place. They may be homeless, or staying with family members on an impermanent basis — the often-described "hidden homeless." Some have reported to providers that they did return the forms and were disenrolled anyway.

In addition, there had been some confusion over who needed to re-enroll. At one point in recent weeks, DHS indicated families with children would be automatically, "passively" renewed, and then reversed that instruction, saying that most of the 320,000 Quest clients — excluding the aged blind and disabled — would have to re-enroll.

Under these circumstances, DHS owes the public better service with the remaining notices to be mailed over the coming months. DHS officials said they already have partnerships with health clinics that should be helping with outreach, but better coordination of efforts is clearly needed, as well as a more robust media campaign. Among the various options for communications: A hotline could be established, enabling clients who are afraid of being dropped from Medicaid to get some guidance.

DHS is telling those who were dropped that they can get coverage through the Hawaii Health Connector, but even with subsidies, this is unaffordable to many. Officials said dropped clients can reapply for Medicaid and have eligibility reviewed within a day or two, using the new computerized system. However, avoiding the enrollment churn, if possible, would be preferable to putting clients through this stress.

It’s clear that under the law DHS needs to pursue the required information on income and tax status for each account. Without updating files, the state was paying out public funds for some clients who may no longer qualify or who have insurance from another source. The state pays insurance companies $1,500 annually per beneficiary, so the cost of overpayment is significant.

But for the beneficiaries who qualify for Medicaid, maintaining unbroken health care coverage could be a life-or-death concern. Fulfilling the program’s primary directive — to see that poorer families who need Medicaid can get it — has to be Job 1.