Nearly 331,000 in state cov­ered by Med­i­caid ex­pan­sion pro­gram

Northwest Arkansas Democrat-Gazette - - NORTHWEST ARKANSAS - ANDY DAVIS

En­roll­ment in Arkansas’ ex­panded Med­i­caid pro­gram topped 333,000 in Novem­ber be­fore drop­ping to about 331,000 at the end of the year, ac­cord­ing to state fig­ures re­leased Thurs­day.

The num­bers also show the cost of the pri­vate op­tion, which cov­ers most of the newly el­i­gi­ble Med­i­caid re­cip­i­ents, to­taled about $1.5 bil­lion in 2016, com­pared with about $1.2 bil­lion in 2015 and $774 mil­lion in 2014.

The fed­eral gov­ern­ment paid the full cost of the ex­panded Med­i­caid pro­gram through the end of last year, but start­ing this year, Arkansas is re­spon­si­ble for 5 per­cent of the cost.

Un­der the 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act, the state’s share is to rise each year un­til it reaches 10 per­cent in 2020.

Through a spokesman, Gov. Asa Hutchin­son said en­roll­ment is “too high” and il­lus­trates the need for changes to the pro­gram be­yond those that went into ef­fect Jan. 1, when the pro­gram of­fi­cially be­came known as Arkansas Works.

Hutchin­son has said he’s asked Pres­i­dent-elect Don­ald Trump to al­low states to re­strict el­i­gi­bil­ity for ex­panded Med­i­caid with­out giv­ing up the en­hanced fund­ing made avail­able through the Af­ford­able Care Act.

With­out the en­hance­ment, Arkansas would be re­spon­si­ble for about 30 per­cent of the cost of ex­panded Med­i­caid.

Hutchin­son said he also wants the states to be al­lowed to im­pose work re­quire­ments sim­i­lar to those that led to about 25,000 Arkansans los­ing their food-stamp ben­e­fits af­ter the state be­gan en­forc­ing the re­quire­ments for that pro­gram last year.

“We were de­nied the flex­i­bil­ity we needed” from Pres­i­dent Barack Obama’s ad­min­is­tra­tion, Hutchin­son spokesman J.R. Davis said. “We’re op­ti­mistic that we’ll get that flex­i­bil­ity from the new ad­min­is­tra­tion.”

Ap­proved by the Repub­li­can-con­trolled Leg­is­la­ture and then-Gov. Mike Beebe, a Demo­crat, in 2013, the ex­pan­sion of the state’s Med­i­caid pro­gram ex­tended el­i­gi­bil­ity to adults with in­comes of up

to 138 per­cent of the fed­eral poverty level.

Un­der cur­rent fed­eral poverty guide­lines, the cut­off is $16,394 for an in­di­vid­ual or $33,534 for a fam­ily of four.

En­roll­ment as of Dec. 31 in­cluded 308,568 who were as­signed to the pri­vate op­tion, which uses Med­i­caid funds to buy cov­er­age in plans of­fered through the state’s health in­sur­ance ex­change.

The re­main­ing 22,375 Arkansans were as­signed to the tra­di­tional, fee- for- ser­vice Med­i­caid pro­gram be­cause they were con­sid­ered “med­i­cally frail,” with health needs that are typ­i­cally not cov­ered by pri­vate in­sur­ance plans.

Ac­cord­ing to the De­part­ment of Hu­man Ser­vices’ fig­ures re­leased Thurs­day, en­roll­ment rose to 333,776 as of Nov. 30 be­fore fall­ing to 330,943 as of Dec. 31. To­tal en­roll­ment on Sept. 30 was 324,318, ac­cord­ing to DHS records.

State of­fi­cials in 2013 pre­dicted that about 250,000 Arkansans would be el­i­gi­ble for cov­er­age un­der the ex­pan­sion.

The fed­eral waiver au­tho­riz­ing the pri­vate op­tion makes Arkansas re­spon­si­ble for costs that ex­ceed a cap that will be cal­cu­lated over the ini­tial three-year “demon­stra­tion pe­riod” based on yearly per-en­rollee tar­gets.

The fig­ures re­leased Thurs­day in­di­cate that the pro­gram’s monthly cost in 2016 av­er­aged about $496.91 per per­son, well be­low the cap for 2016 of $523.58.

Over all three years, the to­tal cost of about $3.5 bil­lion from 2014-2016 ap­pears to be about $100 mil­lion less than the to­tal al­lowed un­der the cap.

The per per­son tar­get in­creased this year to $570.50 un­der the five-year Arkansas Works waiver.

Although Trump and the Repub­li­can- con­trolled Congress have vowed to re­peal the Af­ford­able Care Act, Hutchin­son has said he hopes Trump and Congress will pre­serve the Med­i­caid ex­pan­sion while trans­form­ing Med­i­caid into a “block grant” and giv­ing states more flex­i­bil­ity to de­cide how to ad­min­is­ter the pro­gram.

In ad­di­tion to peo­ple cov­ered by the ex­panded part of the Med­i­caid pro­gram, about 750,000 Arkansans are cov­ered by tra­di­tional Med­i­caid pro­grams serv­ing chil­dren from low in­come fam­i­lies, dis­abled peo­ple and the el­derly poor, in­clud­ing those in nurs­ing homes.

In a let­ter this week re­spond­ing to a query by sev­eral con­gress­men, Hutchin­son said he sup­ports re­peal­ing the Af­ford­able Care Act, abol­ish­ing fed­eral health in­sur­ance ex­changes, which serve Arkansas and more than 30 other states, and scrap­ping re­quire­ments for health plans to of­fer a com­pre­hen­sive set of health ben­e­fits.

He said he sup­ports of­fer­ing tax credits for health in­sur­ance, but said they should be tied solely to in­come, not the cost of cov­er­age.

Un­der cur­rent law, such credits, avail­able to many peo­ple who don’t qual­ify for Med­i­caid and have in­comes of 100 to 400 per­cent of the poverty level, are typ­i­cally paid di­rectly to in­sur­ance com­pa­nies to off­set the cost of cov­er­age. The size of the credit de­pends on the en­rollee’s in­come as well as the cost of cov­er­age in the re­gion.

Un­der Arkansas Works, en­rollees with in­comes above the poverty level are be­ing charged pre­mi­ums of $13 a month start­ing this month. The state also will pro­vide cov­er­age through em­ployer-spon­sored plans in­stead of through the pri­vate op­tion to em­ploy­ees of par­tic­i­pat­ing small busi­nesses.

In Novem­ber and De­cem­ber, en­rollees were also sent in­for­ma­tion about job­search train­ing pro­grams of­fered by the De­part­ment of Work­force Ser­vices, Hu­man Ser­vices De­part­ment spokesman Amy Webb said.

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