Med­i­caid push on to add Mar­shallese kids

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

Mar­shallese chil­dren liv­ing in Arkansas would be­come el­i­gi­ble for cov­er­age through the state’s’ Med­i­caid pro­gram un­der reg­u­la­tions pro­posed by the state De­part­ment of Hu­man Ser­vices.

The pro­posal, which will be sub­mit­ted for ap­proval to the fed­eral gov­ern­ment and the state Leg­isla­tive Coun­cil, would also elim­i­nate a re­quire­ment that other chil­dren who are le­gal im­mi­grants live in the coun­try five years be­fore be­com­ing el­i­gi­ble for Med­i­caid.

The changes would take ef­fect Jan. 1, Hu­man Ser­vices De­part­ment spokesman Brandi Hin­kle said.

Laura Kel­lams, North­west Arkansas di­rec­tor for Arkansas Ad­vo­cates for Chil­dren and Fam­i­lies, said the change would ex­tend cov­er­age to about 2,000 Mar­shallese chil­dren from low-in­come fam­i­lies, as well as a smaller num­ber of non-Mar­shallese im­mi­grants who have been in the coun­try for fewer than five years.

Peo­ple in the coun­try il­le­gally are not el­i­gi­ble for Med­i­caid.

A 1986 com­pact al­lows ci­ti­zens of the Mar­shall Is­lands un­re­stricted travel to the United States, but they were made in­el­i­gi­ble for fed­er­ally sup­ported Med­i­caid cov­er­age by the wel­fare over­haul law signed by Pres­i­dent Bill Clin­ton in 1996.

Most other le­gal im­mi­grants who would oth­er­wise qual­ify for Med­i­caid be­come el­i­gi­ble af­ter liv­ing in the United States for five years.

A 2009 fed­eral law gave states the op­tion to ex­tend Med­i­caid cov­er­age to chil­dren from the Mar­shall Is­lands and other na­tions cov­ered un­der such com­pacts.

Thirty-one other states and the Dis­trict of Columbia have ex­panded cov­er­age as al­lowed un­der the 2009 law, Kel­lams said. An­other state, Ne­vada, is also in the process of im­ple­ment­ing the change, she said.

“Our ar­gu­ment is that it’s a mat­ter of fair­ness” to ex­tend el­i­gi­bil­ity to the Mar­shallese, since im­mi­grants from other coun­tries can even­tu­ally qual­ify for Med­i­caid, Kel­lams said.

Ac­cord­ing to guid­ance is­sued to states in 2010 by the U.S. De­part­ment of Health and Hu­man Ser­vices’ Cen­ters for Medi­care and Med­i­caid Ser­vices, states that ex­pand cov­er­age for im­mi­grant chil­dren un­der the 2009 law must also elim­i­nate wait­ing pe­ri­ods.

Gov. Asa Hutchin­son sup­ports the pro­posal, spokesman Ken­dall Marr said.

Un­der the 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act, the fed­eral gov­ern­ment in 2015 be­gan cov­er­ing the full cost of cov­er­age for chil­dren un­der the state’s Arkids First Med­i­caid pro­gram.

Pre­vi­ously, the fed­eral gov­ern­ment had paid about 80 per­cent of the cost. In the fis­cal year that ended June 30, 2016, the state Med­i­caid pro­gram spent $1.7 bil­lion on cov­er­age for just over 500,000 chil­dren, ac­cord­ing to a Hu­man Ser­vices De­part­ment re­port.

The cov­er­age is avail­able to chil­dren in fam­i­lies with in­comes of up to 216 per­cent of the poverty level: for ex­am­ple, $53,136 for a fam­ily of four.

Marr said the en­hanced fed­eral fund­ing made the ex­pan­sion more fi­nan­cially fea­si­ble for the state. Re­cent im­prove­ments to the state’s com­put­er­ized en­roll­ment and el­i­gi­bil­ity sys­tem for Med­i­caid also made the change eas­ier to im­ple­ment, he said.

Kel­lams said the ad­vo­cacy of Rep. Jeff Williams, R-Spring­dale, whose dis­trict is home to a large Mar­shallese pop­u­la­tion, also helped spur the state to move for­ward.

Dur­ing this year’s leg­isla­tive ses­sion, Williams and Sen. Lance Eads, also a Spring­dale Repub­li­can, spon­sored a res­o­lu­tion, passed by law­mak­ers, that called on Hutchin­son to pur­sue the cov­er­age ex­pan­sion.

Hutchin­son signed the res­o­lu­tion at a cer­e­mony in March at­tended by Ger­ald Zack­ios, the is­lands’ am­bas­sador to the United States.

“We’re very proud of the re­la­tion­ship that we have,” Hutchin­son said at the cer­e­mony. “You’re so much a part of the fab­ric of the com­mu­nity of North­west Arkansas.”

Williams, who was elected to his first term last year, said Tues­day that the is­sue is “im­por­tant for a large por­tion of my con­stituents.”

“This is just cor­rect­ing a wrong that was done some 20 years ago,” Williams said. “It’s just about time we get this straight­ened out and cor­rected.”

North­west Arkansas is home to an es­ti­mated 8,000 to 12,000 Mar­shallese, the largest pop­u­la­tion of the is­lan­ders in the con­ti­nen­tal United States.

Cur­rently, the state Med­i­caid pro­gram pays for ex­penses re­lated to preg­nancy and child­birth for Mar­shallese women with in­comes of up to 214 per­cent of poverty. Mar­shallese adults are oth­er­wise barred from cov­er­age un­der the 1996 wel­fare over­haul. That wouldn’t change un­der the pro­posed reg­u­la­tions.

Mar­shallese adults and chil­dren are el­i­gi­ble for tax-credit sub­si­dies pro­vided un­der the Af­ford­able Care Act to help buy cov­er­age of­fered on the state’s health in­sur­ance ex­change, which is ac­ces­si­ble through the fed­eral site, health­care.gov.

The sub­si­dies are avail­able to peo­ple who don’t qual­ify for Med­i­caid or other gov­ern­ment health pro­grams and have in­comes of 100-400 per­cent of the fed­eral poverty level.

The United States took con­trol of the is­lands from Ja­pan dur­ing World War II and tested nu­clear weapons there be­tween 1947 and 1962. The Com­pact of Free As­so­ci­a­tion, which went into ef­fect in 1986, gave the is­lands in­de­pen­dence while also al­low­ing Mar­shallese ci­ti­zens to live and work in the United States with­out visas.

The Hu­man Ser­vices De­part­ment pub­lished the pro­posed reg­u­la­tions on the state Med­i­caid pro­gram web­site last week. The de­part­ment is ac­cept­ing writ­ten com­ments on the pro­posed changes through Aug. 21.

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