Sav­ing Med­i­caid ex­pan­sion in Ark. re­quired killing it first

Modern Healthcare - - REGIONAL NEWS - —Har­ris Meyer

Arkansas’ Repub­li­can-con­trolled Leg­is­la­ture, in­clud­ing Demo­cratic mem­bers, voted last week to kill the state’s suc­cess­ful Med­i­caid ex­pan­sion.

But it was just a tac­tic to get around a mi­nor­ity of con­ser­va­tive GOP se­na­tors who had enough votes to end the ex­panded pro­gram.

As planned, Repub­li­can Gov. Asa Hutchin­son is­sued a line-item veto strip­ping out lan­guage in the new bud­get bill that would have ter­mi­nated the pro­gram at the end of this year. The ma­neu­ver is likely to face a le­gal chal­lenge.

A num­ber of states have gone through tor­tu­ous po­lit­i­cal pro­cesses to ex­pand Med­i­caid to low-in­come adults un­der the Af­ford­able Care Act. But Arkansas, which orig­i­nally im­ple­mented a cus­tom­ized ex­pan­sion un­der a Demo­cratic gov­er­nor in 2014, ar­guably wins the prize for the most byzan­tine ma­neu­ver­ing.

Hutchin­son, who pre­vi­ously op­posed Med­i­caid ex­pan­sion, even­tu­ally ac­cepted it af­ter his 2014 elec­tion, although he wants to add per­sonal re­spon­si­bil­ity fea­tures, such as pre­mium pay­ments, to the pro­gram. He needed a three-quar­ters vote in both leg­isla­tive cham­bers to au­tho­rize his Arkansas Works plan, and warned that the loss of fed­eral Med­i­caid ex­pan­sion funds would leave a $100 mil­lion hole in the state bud­get that be­gins July 1. Hence the line-item veto strat­egy.

The Arkansas Works waiver plan still needs CMS ap­proval. In an April 5 let­ter to Hutchin­son, HHS Sec­re­tary Sylvia Mathews Bur­well of­fered ten­ta­tive sup­port.

Arkansas Gov. Asa Hutchin­son

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