Another arithmetic lesson

LITTLE ROCK — Republican state legislators request that I stop invoking the prospect of grandma getting kicked out of the nursing home.

They say they would never let that happen.

They say Gov. Mike Beebe is simply being Gov. Mike Beebe. By that they mean he is being tactical. They say he is setting up an overstated dire consequence to force them to support federally funded Medicaid expansion.

They say these are separate issues-the existing shortfall exceeding a hundred-million dollars in ongoing Medicaid coverage, and the proposed expansion of Medicaid to a quarter million people with household incomes up to 138 percent of the federal poverty level.

Don’t let the governor mix it all up, they implore.

So I asked Beebe a simple question: Is it truly as basic as that we must choose federal expansion of Medicaid under the Affordable Care Act or discontinue existing Medicaid funding to 10,000 to 15,000 nursing residents receiving Level 3 care, meaning the least intensive?

And he said . . . no.

The last thing he wants is to cut those people off Medicaid, he said. He will endeavor not to have to do it, he said.

But the fact, he said, is that we simply will be killing time toward inevitable Medicaid insolvency if we decline federal Medicaid expansion and finagle some other stopgap way to keep these people covered.

I don’t quite find him guilty of a cynical ploy. He is seeking mainly to force Republicans to confront their own rhetoric about limited government and reduced spending.

He is advancing the point that Republicans can’t get away with deploring government spending in general and then clinging desperately to government spending when we get down to the mathematically problematic specifics.

He is seeking to get these Republicans to confront the basic arithmetic about which I wrote the other day, and about which, by the way, I received several queries and challenges.

For example, someone wanted to know why I would write that discontinuing Level 3 funding for nursing homes would force families to take grandma home or pay thousands of dollars privately to continue nursing home care, then save the state $35 million. That’s only a few hundred dollars per patient.

First, that $35 million in savings is for part of a year, from January 1, 2014, until the end of the state fiscal year June 30. The estimate for the ensuing first full state fiscal year is $84 million.

Second, Medicaid payments per resident are supplemental and varying. They are based on the individual income of that resident, most of which is taken by the state and applied to the nursing-home charges.

Medicaid eligibility requires a monthly individual income of less than $2,094. If a resident has no income other than a tiny Social Security check, and no assets to tap, then Medicaid covers practically the entire bill, indeed amounting to thousands each month. But if a resident has income closer to the threshold, then the state’s supplemental share is less.

Either way, discontinuing Level 3 nursing-home coverage in Medicaid would require families to come up with not-inconsequential new monthly private sums-a few hundred dollars or several hundred dollars-or take care of the loved one at home.

Meantime, the state is saying that accepting the Medicaid expansion at full federal funding would save the state $44 million that first partial year, and more than $90 million the first full year, from what it pays now forexisting and unexpanded Medicaid.

People have written to ask how that could possibly be so.

First of all, some expenditures now covered at the federal-state matching rate of 73-27 would go under expansion to full federal funding or 90 percent federal funding.

That primarily results from 100 percent federal funding for pregnant women’s services and 100 percent federal funding for Part B of ARKids First, which already covers-at a special federal match of 79-21-children in families with household incomes up to double the federal poverty rate.

Secondly, the Medicaid expansion would absorb those quarter-million working poor people who make too much for existing Medicaid and who often have no insurance at all, or money, when they go to the emergency room.

Expanding Medicaid to cover them would take their tab off the uncompensated-care line at UAMS, where those charges are absorbed by state taxpayers, and transfer it to Medicaid underfull federal funding.

All of that is to say that the most logical statebased solution for our Medicaid shortfall is simply to accept the federal expansion.

Republicans tell me they are warming slightly to the idea of working all this out, perhaps in a way that accepts the Medicaid expansion, but applies new state-specific rules-drug tests and co-payments, primarily.

That probably will require a federal waiver. And a drug test for a lowincome working man needing medical treatment is an insult.

But if it makes Republicans feel better and thus clears the way for the state to accept arithmetic, then you might want to invest in plastic cups or a urinalysis lab.

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.