A smart and kind move
The Hutchinson administration has improved from filing one of the worst state requests for a Medicaid waiver ever to filing one of the better ones.
A pandemic is no time for reactionary right-wing superficiality as usual. It’s time for proactive innovation. The Hutchinson administration is thus rising to the occasion.
Medicaid is a federal-state partnership for health insurance coverage for the poor and disabled in which the federal government provides most of the money. The states provide a match and run the program within the bounds of federal guidelines.
Federal law allows states to conceive of their own variations in Medicaid offerings and processes and to request waivers for “demonstration projects” allowing them to test these new ideas.
Amid modern Trumpian meanness, which is popular in our state, Arkansas was the second state to request—and ignominiously the first to implement—a waiver for a “work requirement” for Medicaid.
Kentucky was the first to request one, but it got pre-emptively stopped by a court, and then Kentucky elected a Democratic attorney general as governor, and he knew better and called the whole thing off.
Arkansas barreled ahead. Medicaid recipients were required to report— at first only online—that they were working or looking for work or volunteering. Thousands didn’t respond and were purged as if to produce evidence of liberal fraud and abuse.
What it proved more credibly was that not all poor people will go to their computers and exercise mouse dexterity when told to do so.
A federal appellate court predictably threw out the Arkansas program because Medicaid exists by law to extend health care to the needy, not to punish.
People should work if they are able, of course. But denying them basic medical treatment is not the legal or decent way to advance that premise.
But enough of that. The courts deep-sixed the work requirement, thank goodness. And, on its best days, which are these, the Hutchinson administration is a darned sight better than that.
Last week, as part of his administration’s continuing demonstration of competence in the coronavirus response, Gov. Asa Hutchinson announced that the state was seeking a waiver to rearrange its current Medicaid expenditures to meet the emergency circumstance.
It proposed to provide extra emergency pay to nursing home nurses and nursing assistants, subsidize small hospitals for capital improvements related to the virus such as drive-through testing, enhance foster-care pay while schools and child-care centers are closed, expand telemedicine, adapt transportation aid to reimburse travel to get prescriptions filled for homebound persons, and move the homeless into shelters.
Bear in mind that the waiver is only for the federal-state partnership providing Medicaid. That’s the primary source of funding for nursing homes, which is why the waiver request affects nursing home nurses. Hospitals, less dependent on Medicaid, are getting new sums of money from the federal stimulus bill, as well as in Medicare, and their nurses should benefit from that.
The raises for nurses and nursing aides in long-term care facilities would amount under the waiver to $250 a week generally and $500 a week in nursing homes facing active coronavirus cases.
As for the other waiver services: Foster care is heavily subsidized by Medicaid. The homeless are typically Medicaid-eligible. Rural hospitals are generally needier for cash than large urban ones, and there is a dearth of testing for Medicaid recipients in rural areas.
The waiver would be for eight weeks with a provision to extend if the emergency persists.
It should cost the state nothing in general revenue.
Other medical services under Medicaid are declining during the coronavirus epidemic, freeing up cash. That’s because services currently are focused on containing the epidemic. Other procedures get canceled or postponed.
Beyond that, the federal government is sending new levels of Medicaid matching money in the stimulus bill. And the state has a Medicaid trust fund to tap instead of general revenue.
For all those reasons, the waiver request is smart, timely and well-designed. It is purely a state initiative. There is no information on any other state seeking an emergency waiver of this type, although even more states ought to follow this Arkansas example than fell in behind that meanness waiver of which I am no longer speaking.
Hutchinson says he expects quick federal approval, since the matter is an emergency and some of the framework had been pre-submitted for federal review.
The request was formally submitted Thursday. I hope it’ll be approved by the time you read this column.
The Trumpian director of Medicaid programs, Seema Verma, came to Little Rock years ago to make a big show of signing the doomed work-requirement waiver. Hutchinson thought an on-site Trumpian would impress right-wing legislators.
Verma can stay in Washington for this signature. This waiver is simply to help the state help people, not punish them for show.