Med­i­caid ex­ten­sion rolls fall

8,000 fewer; cost per en­rollee dips

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - ANDY DAVIS

En­roll­ment in the ex­panded part of Arkansas’ Med­i­caid pro­gram fell in June by al­most 8,000 peo­ple, ac­cord­ing to the state Depart­ment of Hu­man Ser­vices.

Dur­ing the same month, the av­er­age cost to the pro­gram for those in sub­si­dized, pri­vate-in­surance plans fell by more than $24, to $502.52 per per­son.

The drop in en­roll­ment likely re­flects the depart­ment’s con­tin­u­ing ef­fort to ter­mi­nate cov­er­age for those who are no longer el­i­gi­ble, depart­ment spokesman Brandi Hin­kle said.

Since Jan. 31, en­roll­ment has fallen by more than 25,000 peo­ple, from 334,113 to 308,672 as of June 30.

“I think it’s ob­vi­ously good news,” J.R. Davis, a spokesman for Gov. Asa Hutchin­son, said.

Hutchin­son has ex­pressed con­cern about the cost of the pro­gram, known as Arkansas Works, as en­roll­ment surged past the 250,000 peo­ple state of­fi­cials ini­tially es­ti­mated would be made el­i­gi­ble by the ex­pan­sion.

The state has asked the fed­eral gov­ern­ment for per­mis­sion to trim en­roll­ment fur­ther start­ing Jan. 1, by lim­it­ing el­i­gi­bil­ity to peo­ple with in­comes of up to the poverty level, rather than 138 per­cent of the poverty level.

The state is also seek­ing ap­proval to im­pose a work re­quire­ment on many of those who would re­main en­rolled.

Un­der the 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act, the fed­eral gov­ern­ment paid the full cost of cov­er­age for the newly el­i­gi­ble adults dur­ing the first three years of the ex­pan­sion, from 2014-2016.

Start­ing in Jan­uary, Arkansas be­came re­spon­si­ble for 5 per­cent of the cost of the pro­gram. The law calls for the state’s share to rise to 6 per­cent next year, then con­tinue ris­ing each year un­til it reaches 10 per­cent in 2020.

Dur­ing the fis­cal year that ended June 30, the cost to­taled more than $1.9 bil­lion, with the fed­eral gov­ern­ment pay­ing all but $48.6 mil­lion, Hin­kle said.

The pro­gram’s pro­jected cost this fis­cal year is $1.8 bil­lion, with the state pay­ing $100 mil­lion, Hin­kle said.

The June en­roll­ment tally in­cluded 285,786 peo­ple en­rolled in the so-called pri­vate op­tion, which uses Med­i­caid funds to buy cov­er­age in plans on the state’s health in­surance ex­change.

The other 22,886 Arkansans were as­signed to the tra­di­tional fee-for-ser­vice Med­i­caid pro­gram be­cause they were con­sid­ered “med­i­cally frail,” with health needs pri­vate plans typ­i­cally don’t cover.

Un­der the fed­eral waiver au­tho­riz­ing Arkansas Works, the state will owe money to the fed­eral gov­ern­ment if the cost of the sub­si­dized pri­vate cov­er­age from 20172021 ex­ceeds a limit that will be cal­cu­lated us­ing an­nual per-en­rollee cost caps.

Through June of this year, the state’s av­er­age per-en­rollee cost was $526.74. The cap this year is $570.50.

The cost in June in­cluded an av­er­age pay­ment to in­surance com­pa­nies of $498.65 — $24.35 lower than the av­er­age per-per­son pay­ment in May.

The pay­ment in­cludes a pre­mium and an ad­di­tional sub­sidy, known as a cost-shar­ing re­duc­tion pay­ment, that is tied to the pre­mium amount and re­duces an en­rollee’s out-of-pocket costs for med­i­cal care.

From May to June, the av­er­age pre­mium fell $17.68 to $361.61 and the av­er­age cost-shar­ing re­duc­tion sub­sidy fell $6.67 to $137.04.

The Med­i­caid pro­gram also pays di­rectly for cer­tain ben­e­fits, such as non­emer­gency med­i­cal trans­porta­tion, that pri­vate plans don’t cover. The av­er­age cost of those ben­e­fits fell 1 cent in June, to $3.87.

The drop in the av­er­age per-en­rollee pay­ment to in­surance com­pa­nies was the largest such de­crease since the ex­panded cov­er­age kicked in in 2014.

The next-largest drop was a de­crease of $10.28 from March to April of last year.

Pre­mi­ums vary ac­cord­ing to the plan and re­gion of the state, and are higher for older en­rollees than for younger ones.

Hin­kle said in an email that “pre­mi­ums have been de­creas­ing monthly,” and that the drop “is likely due to new en­rollees be­ing placed on [plans] that have lower rates.”

She said she didn’t have any fur­ther de­tails Fri­day about the rea­son for the de­crease.

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