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Medicaid bid by Arkansas gets airing in D.C.

Governor, U.S. officials talk about eligibility criteria shift

Arkansas Gov. Asa Hutchinson says he briefed federal officials this week on the state's implementation of a work requirement for its expanded Medicaid program and discussed the state's request to shrink the program by changing the eligibility criteria.

Seema Verma, administrator of the Federal Centers for Medicare and Medicaid Services, in March granted the state's request to impose the work requirement, but did not approve a request to move about 60,000 people off the program by limiting eligibility to those at or below the poverty level.

Currently the program, known as Arkansas Works, covers adults with incomes of up to 138 percent of the poverty level. About 281,000 people were enrolled in the program as of April 1.

Hutchinson said Thursday that he discussed the state's pending request during a meeting in Washington, D.C., with Verma and Eric Hagan, deputy secretary for the U.S. Department of Health and Human Services.

"I know that that's been a continued discussion within the administration, and we have good support for that aspect of the waiver request, and it is still being debated within the [White House Office of Management and Budget] and the broader administration, but there is significant support for it," Hutchinson said during a news conference.

"It also seems that there are other states that are following our lead and looking at that part of our waiver request."

Arkansas on June 1 became the first state to implement a work requirement for its Medicaid program.

Kentucky will begin phasing in its work requirement on July 1. Requirements in Indiana and New Hampshire will start next year.

Of the initial group of 27,000 Arkansas enrollees who became subject to the work requirement this month, 16,000 qualified for automatic exemptions based on information in state records.

Those automatically exempted, for instance, include enrollees living with dependent children or who earn at least $736 a month. That cutoff is based on the average monthly income of someone making the state's minimum wage of $8.50 an hour and working 20 hours a week.

The remaining 11,000 enrollees will have to use a state website, www.access.arkansas.gov, to report whether they qualified for exemptions or spent 80 hours during the month on work or other approved activities.

The state Department of Human Services hasn't received any reports of problems with the online portal, spokesman Marci Manley said Thursday. She added that the portal will be down for maintenance from 7 p.m. today though 7 a.m. Monday.

The requirement is being phased in this year for enrollees aged 30-49 and will start next year for those ages 19-29.

Meanwhile, Arkansas' request to change the income threshold for eligibility has stirred debate among federal officials about the impact granting such requests would have on the federal budget, Hutchinson has said. Massachusetts has also submitted a request to make the change.

In a 2010 report, the Santa Monica, Calif.-based RAND Corp. estimated that setting the eligibility cutoff for Medicaid expansion in all states at 100 percent of the poverty level, instead of 138 percent, would reduce the number of people with insurance and increase the cost to the federal government by $5 billion between 2014 and 2019.

The higher cost would come from shifting people from Medicaid, which is partially supported by states, to private coverage subsidized by the federal government under the Affordable Care Act.

Under the 2010 health care overhaul law, states that expanded Medicaid are responsible for 6 percent of the cost this year. The states' share will rise to 7 percent next year and 10 percent for 2020 and later years.

Allowing states to change the eligibility threshold is "a big policy decision for the administration," Hutchinson said.

"That will take some time, but that was one of the big topics we had in the conversation," he said. "We want to keep it in front of them."

Metro on 06/08/2018

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