Medicaid work-rule help set; health insurers to educate enrollees on state requirement


Photographs by Staton Breidenthal

Human Services Director Cindy Gillespie on Thursday explains the schedule for rolling out the new work requirement for enrollees in the expanded Medicaid program.

The three insurance companies participating in Arkansas Works will help educate enrollees about the work requirement set to take effect June 1, representatives of the companies said Thursday.

Michael Stock, chief executive of Little Rock-based QualChoice Health Insurance, said his company will communicate with enrollees through phone calls, emails, letters and text messages.

"We've tried to create a tiered messaging system, so that as people become at risk of losing coverage, we increase the frequency and urgency of that messaging to the individual," Stock said.

Stock and representatives from Arkansas Blue Cross and Blue Shield and St. Louis-based Centene spoke at a news conference Thursday on the Department of Human Services' plans to implement the requirement, which the federal Centers for Medicare and Medicaid Services approved Monday.

Before the requirement can go fully into effect, the federal agency must approve the department's implementation plan, including a strategy for educating enrollees about the requirement.

Mary Franklin, director of the Human Services Department's County Operations Division, said the department will submit the plan in time for it to be approved before the June 1 start date.

After the meeting, Kevin De Liban, an attorney with the Jonesboro-based Legal Aid of Arkansas, said his organization also will help spread the word about the requirement through presentations to community health centers, mental-health clinics, food pantries and other organizations.

But the requirement will likely cause some people to lose coverage, he said.

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Experience with other programs shows that "when you make people jump through more hoops, they trip and fall on the way," he said.

The requirement to spend 80 hours a month on work or other approved activities is among a number of changes Gov. Asa Hutchinson sought to make to Arkansas Works, which covers people who became eligible for Medicaid under the expansion of the program in 2014.

The program was covering 284,670 people as of March 1, department spokesman Amy Webb said.

Most enrollees receive the coverage through private plans offered on the state's health insurance exchange, with the Medicaid program paying most or all of the premium.

The Human Services Department estimated that the work requirement would reduce the cost of the program in the fiscal year that starts July 1 by about $49 million if it went into effect July 1 and caused about 20 percent of enrollees subject to it to lose coverage during the year.

Webb said this week that the estimate is "old and inaccurate" and is being updated.

Hutchinson also sought to move about 60,000 people off the program by reducing the income cutoff to the poverty level, instead of 138 percent of the poverty level, but the Centers for Medicare and Medicaid Services has yet to approve that request.

The work requirement applies only to enrollees with incomes up to the poverty level who are younger than 50. It will apply this year to enrollees age 30-49 and next year to those age 19-29.

Of the 99,000 enrollees in the older age group, about 60,000 won't have to take action because state records indicate they already are in compliance or are exempt, Human Services Department officials said.

For instance, automatic exemptions will be given to enrollees making at least $736 a month -- the average monthly income of someone making the state's minimum wage of $8.50 an hour and working 20 hours a week.

Other automatic exemptions will go to enrollees who are receiving food stamps and exempt from that program's work requirement, considered "medically frail" based on their answers to questions about their health status, living with a dependent child, pregnant or receiving welfare or unemployment benefits.

Those not automatically exempt will have to use a state website to report whether they spent 80 hours during a month on work or other approved activities or qualified for an exemption.

The approved activities include attending high school or college classes, participating in job training and performing community service. Enrollees also will get credit for up to 40 hours a month of searching for a job or participating in job-search training and up to 20 hours a year of health-related classes.

Exemptions that must be reported through the website will be available to enrollees who are caring for an "incapacitated person," people who have a "short-term incapacitation," enrollees who are in drug and alcohol treatment and full-time students.

Those who fail to meet the requirement for three months during a year will be terminated from the program and won't be able to re-enroll until the beginning of the next year.

Enrollees will have to report on their activities or exemption status for each month by the fifth day of the following month. Those who fail to comply for three months will receive notices informing them that their coverage will end at the end of the third month.

If they come into compliance by the fifth day of the month after their coverage ends, however, the coverage will be restored.

Notices about the work requirement will go out to all Arkansas Works enrollees by March 15, Franklin said.

The website will go live March 30, and additional notices will go out early next month to enrollees who will be subject to the work requirement this year with instructions on how to use the site, she said.

Also in April, the department will begin sending weekly files to the insurance companies and the Arkansas Foundation for Medical Care, which operates a Medicaid call center, with information on when each enrollee will become subject to the requirement and whether he is in compliance.

The requirement will be phased in for groups of enrollees according to the date when the department normally reviews each person's eligibility, Franklin said. For instance, it will start in June for about 8,600 enrollees, whose eligibility reviews happen in January, February and March.

The month before the requirement takes effect for each group of enrollees, the department will send them notices with information on whether they qualify for automatic exemptions or need to visit the website.

The Arkansas Foundation for Medical Care will also call each enrollee to offer information about the requirement.

Representatives of Arkansas Blue Cross and Blue Shield and Centene said they also plan to contact customers affected by the requirement. Matthew Vanatta, an executive at Arkansas Blue Cross and Blue Shield, said his company will educate health care providers about the requirement, and it will alert insurance agents when one of their clients is about to lose coverage.

John Ryan, chief executive of Centene subsidiary Celtic Insurance Co., said his company will have information on where enrollees who lack Internet access can use the website. For instance, it will be accessible through kiosks at each of the Human Services Department's 83 offices around the state. Enrollees also can use computers at the Department of Workforce Services' 32 offices and three satellite offices.

Metro on 03/09/2018

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