State asks U.S. OK to ad­just Med­i­caid

60,000 en­rollees would exit ex­pan­sion

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - MICHAEL R. WICKLINE

The state sub­mit­ted pro­posed changes to Ar­kan­sas’ Med­i­caid ex­pan­sion to the Trump ad­min­is­tra­tion on Fri­day, in­clud­ing plac­ing a limit on el­i­gi­bil­ity for adults that is ex­pected to remove 60,000 en­rollees from the pro­gram and adding a work re­quire­ment.

The pro­gram, known as Ar­kan­sas Works, pro­vides health cov­er­age to roughly 300,000 Arkansans.

Gov. Asa Hutchin­son has pro­posed lim­it­ing el­i­gi­bil­ity to adults with in­comes at or be­low 100 per­cent of the fed­eral poverty level in­stead of the cur­rent 138 per­cent of the poverty level.

At 138 per­cent of the fed­eral poverty line, the pro­gram’s cur­rent in­come cut­offs are at $16,643 for an in­di­vid­ual and $33,948 for a fam­ily of four. That would go down on Jan. 1 to about $12,060 for an in­di­vid­ual and $24,600 for a fam­ily of four if the fed­eral gov­ern­ment ap­proves the waiver re­quest.

The pro­posed changes also would elim­i­nate Ar­kan­sas Works’ em­ployer-spon­sored in­sur­ance pre­mium as­sis­tance pro­gram on Dec. 31 and al­low the state to stop pro­vid­ing re­im­burse­ment for med­i­cal bills in­curred up to three months be­fore a Med­i­caid ap­pli­ca­tion is sub­mit­ted.

“To­day’s sub­mis­sion of waivers to the fed­eral gov­ern­ment is good news,” Hutchin­son said in a writ­ten state­ment.

“It fur­ther il­lus­trates our com­mit­ment to re­form our Med­i­caid pro­gram to make sure it is af­ford­able to the state and that it in­stills rea­son­able work re­quire­ments for able-bod­ied in­di­vid­u­als. We are hope­ful the Trump Ad­min­is­tra­tion will re­spond quickly to this waiver re­quest,” the Repub­li­can gov­er­nor said.

To­gether, the pro­posed amend­ments “seek to test in­no­va­tive ap­proaches to pro­mot­ing per­sonal re­spon­si­bil­ity and work, en­cour­ag­ing move­ment up the eco­nomic lad­der, and fa­cil­i­tat­ing tran­si­tions from Ar­kan­sas Works to em­ployer-spon­sored in­sur­ance and Mar­ket­place cov­er­age,” Hutchin­son said in a let­ter dated Fri­day to U.S. Depart­ment of Health

and Hu­man Ser­vices Sec­re­tary Tom Price.

The Repub­li­can-dom­i­nated Leg­is­la­ture in a May spe­cial ses­sion en­dorsed the changes, which Hutchin­son said are aimed at mak­ing the Ar­kan­sas Works pro­gram sus­tain­able.

Rich Hud­dle­ston, ex­ec­u­tive di­rec­tor of the Ar­kan­sas Ad­vo­cates for Chil­dren and Fam­i­lies, said Fri­day that he still be­lieves re­duc­ing the el­i­gi­bil­ity for the Ar­kan­sas Works pro­gram is “a bad idea” and the work re­quire­ments aren’t nec­es­sary.

He also said that he’s glad that Ar­kan­sas still has a Med­i­caid ex­pan­sion pro­gram and cred­ited Hutchin­son for that.

State of­fi­cials ex­pect to hear back from the Trump ad­min­is­tra­tion on the re­quest for waivers within the next 90 days, said Amy Webb, state Depart­ment of Hu­man Ser­vices spokesman.

The state re­ported that in re­sponse to the pro­posed changes, sev­eral peo­ple ex­pressed op­po­si­tion to the waiver re­quest, as well as con­cern that chang­ing the in­come el­i­gi­bil­ity limit and im­ple­ment­ing work re­quire­ments will in­crease the num­ber of unin­sured.

The state noted that all Arkansans cur­rently en­rolled in the Ar­kan­sas Works pro­gram “will con­tinue to have ac­cess to cov­er­age when the waiver amend­ment is im­ple­mented.”

Arkansans with in­comes above 100 per­cent of the fed­eral poverty level will be able to en­roll in qual­i­fied health in­sur­ance plans on the in­sur­ance ex­change with fi­nan­cial sup­port from tax cred­its and cost-shar­ing re­duc­tion pay­ments or em­ployer-spon­sored cov­er­age, the state said in the waiver re­quest.

Arkansans with in­comes at or be­low the 100 per­cent of the fed­eral poverty level will re­main cov­ered through Ar­kan­sas Works and “may be sub­ject to work re­quire­ments as a con­di­tion of el­i­gi­bil­ity,” the waiver re­quest states.

“The pro­posed waiver amend­ment em­pha­sizes the im­por­tance of per­sonal re­spon­si­bil­ity in main­tain­ing cov­er­age and … DHS will con­duct ex­ten­sive ed­u­ca­tion and out­reach to pro­mote con­ti­nu­ity of cov­er­age,” the state said. “Over the length of the demon­stra­tion, the state will mon­i­tor Ar­kan­sas’

unin­sur­ance rate.”

Ac­cord­ing to the state, three peo­ple ex­pressed con­cerns that the state is seek­ing to change the Ar­kan­sas Works pro­gram while Congress is con­tem­plat­ing sig­nif­i­cant changes to the fed­eral health care land­scape.

Two peo­ple noted in par­tic­u­lar that it was un­clear whether the pre­mium tax cred­its and cost-shar­ing re­duc­tion pay­ments will con­tinue to be avail­able on the in­sur­ance ex­change in the fu­ture. If th­ese sub­si­dies cease to ex­ist, it will be dif­fi­cult for cur­rent Ar­kan­sas Works par­tic­i­pants with in­comes above 100 per­cent of the fed­eral poverty level to find af­ford­able cov­er­age on the in­sur­ance ex­change, those com­ment­ing said.

In re­sponse, the state “agrees that changes in fed­eral sup­port for health in­sur­ance could af­fect op­tions avail­able to in­di­vid­u­als tran­si­tion­ing off Ar­kan­sas Works.”

“Ac­cord­ingly, Ar­kan­sas is closely mon­i­tor­ing leg­is­la­tion be­ing con­sid­ered by Congress,” the state said. “De­pend­ing on what, if any, changes to fed­eral health care pro­grams are en­acted by Congress, the state may con­sider mod­i­fy­ing Ar­kan­sas Works.”

Asked about what those changes would be, Webb said that “it’s too early to say specif­i­cally what we’d have to mod­ify, be­cause Congress has not passed any changes at this point.”

“But we’d go through a process of amend­ing the waiver,” she said.

Un­der the 2010 fed­eral Pa­tient Pro­tec­tion and Af­ford­able Care Act, the fed­eral gov­ern­ment paid the full cost of ex­pand­ing cov­er­age for states, such as Ar­kan­sas, that ex­panded Med­i­caid through the end of last year.

In 2013, the Repub­li­can-con­trolled Leg­is­la­ture and then-Demo­cratic Gov. Mike Beebe au­tho­rized the state’s Med­i­caid ex­pan­sion un­der which the state pays for pri­vate health in­sur­ance for low-in­come Arkansans.

Start­ing in Jan­uary, states be­came re­spon­si­ble for 5 per­cent of the cost of the pro­gram. The cur­rent fed­eral law calls for the state’s share to rise each year un­til it reaches 10 per­cent in 2020.

In fis­cal 2018, which starts to­day, the state projects the Med­i­caid ex­pan­sion to cost $1.8 bil­lion with the fed­eral gov­ern­ment cov­er­ing $1.7 bil­lion of the cost and the state chip­ping in about $109 mil­lion.

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