1st look offered of Arkansas Works

Comment sought on draft of Medicaid expansion request

The Arkansas Department of Human Services on Wednesday opened for public comment a draft of the request it will submit to the federal government to allow changes to the state's private option Medicaid program and extend the waiver authorizing it through 2021.

Gov. Asa Hutchinson has said the changes, endorsed by the state Legislature last month, would encourage enrollees to stay employed and take responsibility for their health care.

The revamped program, now officially known as the Health Care Independence Program, would be renamed Arkansas Works.

The proposed changes, which would take effect Jan. 1, include charging premiums of about $19 a month to enrollees with incomes above the poverty level, providing coverage to some enrollees through subsidized employer plans and offering an extra benefit, such as dental coverage, as an incentive for enrollees to pay premiums and receive annual wellness exams.

The state would also eliminate retroactive coverage for enrollees to "better align" the program with commercial insurance coverage, according to the extension application. The Medicaid program now covers up to 90 days of medical expenses incurred by an enrollee before the date of the initial application.

Under the Human Services Department proposal, coverage would start on the date of application.

The document released Wednesday can be found on the state Medicaid program website.

Human Services Department spokesman Amy Webb said the department plans to submit the application to the Centers for Medicare and Medicaid Services this summer, after a public comment period ends at midnight June 17.

She said the department hopes to receive approval for the requested changes this fall.

The department will also hold public hearings on the waiver application at 11 a.m. May 26 at the University of Arkansas Cooperative Extension Service building at 2301 S. University Avenue in Little Rock and at 5:30 p.m. June 1 at Jefferson Regional Medical Center in Pine Bluff.

Under the private option, the state uses Medicaid funds to buy coverage for low-income Arkansans through the state's federally run insurance exchange.

The state's Republican-controlled Legislature and then-Gov. Mike Beebe, a Democrat, created the program in 2013 as a primary way of extending Medicaid coverage to adults with incomes of up to 138 percent of the federal poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four.

Almost 268,000 Arkansans had been approved for coverage under the expanded Medicaid program as of Jan. 31. That included 212,301 who had enrolled in private plans by Dec. 15 and 22,793 who were assigned to the traditional, fee-for-service Medicaid program because they were determined to have exceptional health needs.

The waiver application lists current enrollment in the private plans at 240,000. Under Arkansas Works, the application predicts enrollment in private individual plans or subsidized employer coverage will grow to 272,000 by 2021.

Excluding premiums paid by enrollees, coverage for those enrolled in private individual plans or employer plans is expected to cost $1.6 billion next year, according to the application.

Under the federal 2010 Patient Protection and Affordable Care Act, Arkansas will be responsible for 5 percent of the cost, or $78 million.

In 2021 the coverage will cost a projected $2 billion, with Arkansas' share, which reaches a maximum of 10 percent in 2020, totalling about $104 million.

The totals exclude the cost of coverage for those who are determined to be "medically frail" -- typically about 10 percent of the total enrollment -- because they are not considered to be part of the Arkansas Works demonstration program.

The terms of the current waiver require the state to demonstrate that the private option doesn't cost more than traditional Medicaid.

Based on that requirement, the current waiver set a cap for the first three years of the program that will be calculated based on monthly per-enrollee cost targets.

If Arkansas' costs exceed the cap, it will owe the difference to the federal government. But the application estimates Arkansas' cost for the three years will total about $3.4 billion, about $42 million below the cap.

Over the next five years, the application predicts Arkansas Works will cost $9 billion, about $328 million less than the application estimates that coverage under the traditional Medicaid program would cost.

The department will also accept written comments on the application through June 17. The comments can be submitted by email to hciw@arkansas.gov or by regular mail to P.O. Box 1437, S-295, Little Rock, Ark. 72203-1437.

A Section on 05/19/2016

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