Arkansas waiver would axe 60,000 from Med­i­caid, add work re­quire­ments

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Hos­pi­tals are op­pos­ing a waiver the state of Arkansas last week sub­mit­ted that would mostly roll back Med­i­caid ex­pan­sion in the state and im­pose a work re­quire­ment on those who re­main in the pro­gram.

The waiver seeks to drop Med­i­caid el­i­gi­bil­ity in the state from 138% of the fed­eral poverty level, or $33,948 for a fam­ily of four as out­lined in the Af­ford­able Care Act, to 100% of the poverty level, or $24,600 for a fam­ily of four. An es­ti­mated 60,000 peo­ple would lose Med­i­caid cov­er­age.

Arkansas of­fi­cials said those peo­ple likely would use tax cred­its and cost-shar­ing re­duc­tion pay­ments to buy in­di­vid­ual plans on the state mar­ket­place, which is cur­rently sta­ble. The in­sur­ers signed up this year have said they in­tend to con­tinue sell­ing plans.

Start­ing Jan.1, those who re­main on Med­i­caid would have to work, par­tic­i­pate in job train­ing, be in school or ac­tively look for em­ploy­ment at least 80 hours a month to keep their in­sur­ance.

Those who don’t com­ply would lose their cov­er­age and be blocked from Med­i­caid un­til the next cal­en­dar year.

The CMS has not yet ap­proved such re­quests. But be­fore be­ing ap­pointed to lead the CMS, its chief, Seema Verma, helped draft state plans that made Med­i­caid pa­tients more re­spon­si­ble for the cost of their care.

The state of Arkansas also wants to end an ACA pro­vi­sion that al­lows peo- ple to ob­tain Med­i­caid cov­er­age the day they ap­ply, as­sum­ing the ap­pli­cant qual­i­fies for ben­e­fits. Providers could no longer bill for ser­vices pro­vided in the three months be­fore the ap­pli­ca­tion, as­sum­ing the pa­tient was el­i­gi­ble dur­ing that time.

There’s been no es­ti­mate on how much un­com­pen­sated care could rise with­out retroac­tive el­i­gi­bil­ity, but rolling back Med­i­caid ex­pan­sion to 100% of the poverty level could lead to as much as $54 mil­lion in un­com­pen­sated costs for hos­pi­tals by 2020, ac­cord­ing to state cal­cu­la­tions.

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