Merit is seen for Medicaid drug test

Two parties agree aid should be aim

Correction: Anna Strong is the health-care policy director for Arkansas Advocates for Children and Families. Her first name was incorrect in this article.

— Drug testing of Medicaid recipients has surfaced as a potential ingredient for a deal expanding the state’s $5 billion program by 250,000 people, but both Republicans and Democrats say tests should be used to steer abusers into treatment - not off the rolls.

“If the issue is to identify someone with a problem and get them to treatment so they no longer have an issue, that’s something that is a potential benefit,” said Dr. Joe Thompson, the state’s surgeon general in a speech Tuesday at the Clinton School of Public Service in Little Rock.

Using testing to deny eligibility for Medicaid would be “shortsighted,” Thompson said, but using testing as a means for more treatment might be “a path that might get us to somewhere that makes sense.”

Two Republicans who sent a letter to Gov. Mike Beebe in July requesting changes to Medicaid, which serves about 780,000 low income people - most of whom are children, the disabled and the elderly - largely concur, arguing that drug testing should be used to help Medicaid recipients, not punish them.

“I would agree that if somebody’s got a substance-abuse problem what they need is help. Removing services from them because they have a medical need is not the right thing to do,” said Rep. Bruce Westerman, a Hot Springs Republican.

Searcy Republican Mark Biviano, a state representative who researched how other states have implemented drug testing for public-assistance recipients, said he has heard from caseworkers who would like to have more power to conduct random drug tests on clients they suspect of having such problems.

“The idea is not to automatically throw them off the benefit. The idea is to give them a chance to go to rehab,” Biviano said.

Medicaid, which faces a $298 million deficit by July, has systemic problems with fraud and abuse, Biviano said, and drug testing, co-payments and other GOP suggestions for fixing the system need to be approached as part of a long-term overhaul of the program.

“We can’t look at this as a two- or three-year problem. We have to look at it as a long-term problem,” Biviano said.

Beebe has said state leaders have time to fashion a compromise on Medicaid expansion, which is part of President Barack Obama’s Patient Protection and Affordable Care Act. In June, the U.S. Supreme Court mostly upheld the law, but said the federal government can’t penalize states that choose not to expand their Medicaid programs to cover those earning up to 138 percent of the poverty rate.

Arkansas Republicans, who captured control of the House and Senate in the Nov. 6 election, have been cool to Medicaid expansion, saying they fear a future increased financial burden on the state. Under the law, the federal government will pay completely for expansion until 2017. By 2020, the state’s share will rise to 10 percent of the cost.

Beebe is open to discussing drug-testing proposals, but other states have run into legal challenges with requiring public-assistance recipients to submit to drug testing, said Matt DeCample, Beebe’s spokesman.

“I think it depends on what it looks like and what the goal is,” DeCample said. “We don’t have any specific ideas in our office. But we’ve got time. [Medicaid expansion] is something that will come up when we’ve been in the session for a while.”

DeCample said Florida is a cautionary example of mixing drug testing and public assistance.

Florida’s drug-testing program of welfare applicants lasted only a few months in 2011 before being taken up by the courts. The Florida chapter of the American Civil Liberties Union sued the state, saying the tests were an unreasonable search and seizure, and violated the Fourth Amendment of the U.S. Constitution.

“Florida was kind of the bellwether for trying to have a pre-emptive drug-screening law,” DeCample said.

A similar law in Georgia has been put on hold until the Florida test case is resolved.

“The whole country is kind of watching this,” DeCample said.

In the four months when Florida conducted drug tests, 2.6 percent of the state’s welfare applicants for cash assistance failed the screening. The law requires that applicants who pass the test be reimbursed for the average $30 cost. The testing cost the state government $45,780, according to The New York Times.

For any Arkansas Medicaid recipient to be subject to drug testing, the federal government would have to sign off on it, probably in the form of a waiver from the Centers for Medicare and Medicaid Services, said Amy Webb, spokesman for the state Department of Human Services. Generally, Webb said, additional eligibility requirements aren’t allowed by the federal government.

“Theoretically, we could ask for a waiver from CMS on this aspect of the rule, but there are issues of constitutionality in case law that our attorneys reviewed,” Webb wrote in an e-mail.

Biviano said he realizes that testing Medicaid or other public-assistance recipients or applicants could end up costing the state money, but he said it is important, especially because many recipients have children who depend on the benefits.

“One of the arguments against it is the cost. But the fact is the benefits greatly outweigh the costs. How do you put a price tag on helping to save a child’s life?”

Ann Strong, health-policy director for Arkansas Advocates for Children and Families, disagrees. Arkansas Advocates opposes using drug testing as a criteria for Medicaid enrollment and said that, in general, the Florida example shows that the approach isn’t cost-effective and is vulnerable to legal challenge.

“We think what’s good for children is for parents to have access to a full range of health services, so they [the youths] have healthy, active and engaged parents,” Strong said. She said that includes the better drug treatment and mental-health services contained in the new health-care law.

Arkansas, Pages 15 on 12/02/2012

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