Wednesday, November 08, 2017

EDITORIAL >> State readies Medicaid cuts

Arkansas Nonprofit News Network

Significant changes to the state’s Medicaid expansion program proposed by Governor Hutchinson — including work requirements and a change in eligibility that would remove tens of thousands of Arkansans from the rolls — were slated to begin Jan. 1. The state is still waiting for federal approval necessary to move ahead.

The governor has consistently stated that he is confident the changes will be approved, but with the proposed implementation date less than two months away, state officials could face challenges staying on schedule.

At a press conference on Oct. 17, Hutchinson expressed some anxiety about the timeline for federal approval given the challenges ahead in initiating new program infrastructure. “It’s very important that we get that word in the near future, just because you have to give notice, you have to change some of the IT systems,” he said. “So there’s work to be done and we are anxious for that to be approved.”

More than two weeks later, the state has still received no word from federal officials.

“We do not yet have a timeline for approval but hope that it is soon,” Department of Human Services spokeswoman Amy Webb said. Asked whether the Jan. 1 start date was still feasible at this point, Webb said, “Once we get that approval, we will need 60 days to implement those changes. We will revise the implementation timeline once we get that approval.”

More than 300,000 Arkansans are currently covered under the Medicaid expansion, which provides health insurance to adults who make less than 138 percent of the federal poverty level (that’s around $16,500 for an individual or $34,000 for a family of four).

The federal Affordable Care Act provides most of the funding for states that have chosen to expand Medicaid. Arkansas opted to do so in 2014, during the Gov. Mike Beebe administration, via a unique approach then known as the private option, which used Medicaid funds to purchase private health care plans for eligible low-income Arkansans.

Hutchinson kept this policy — which he re-branded Arkansas Works — in place, but received federal approval for a new waiver of Medicaid rules to implement a few changes last year, including imposing small premiums on certain beneficiaries.

The election of President Trump opened the possibility for additional changes that the Obama administration would not approve. In June, the state submitted a request for a series of amendments to the Arkansas Works waiver, which would institute four major alterations.

First, the state would reduce the number of people eligible for the program, limiting enrollment to those who make less than 100 percent of the federal poverty level (that’s around $12,000 for an individual or $24,500 for a family of four). According to the DHS, that means around 61,000 current beneficiaries — those who make between 100 and 138 percent of the FPL — would be removed from the program.

Second, the state would impose work requirements on most beneficiaries who remain. Those between the ages of 18-49 would be required to work 80 hours per month; if they were not working, they would have to participate in job training programs or certain approved volunteer activities. Beneficiaries must be in compliance for nine months out of the year or they would be removed from the program for the duration of the year. Beneficiaries 50 or older would not be subject to the work requirement; exemptions would be available for others who met certain criteria, such as caring for dependent children.

Third, the state would eliminate 90-day retroactive eligibility. Currently, enrollees in the program are retroactively covered for any medical expenses arising in the three months before enrolling. The Obama administration already granted a waiver that would allow the state to begin coverage only once a beneficiary was enrolled but attached certain conditions for the state to prove that it would protect continuity of coverage. The state is now asking the Trump administration to remove those conditions and allow it to eliminate retroactive coverage immediately.

Fourth, the state would end a little-used premium assistance program for those with access to employer-sponsored insurance that Hutchinson instituted in the original Arkansas Works waiver; only one beneficiary ever participated in this program.

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Find out more at