Medicaid extension rolls fall
8,000 fewer; cost per enrollee dips
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.