Nearly 331,000 in state covered by Medicaid expansion program
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.