In-and-out Medicaid feared for state’s poor workers

— Large numbers of poor Arkansans will bounce between Medicaid and private, federally subsidized insurance if the state decides to expand its rolls by 250,000 people, state Medicaid and insurance exchange officials said Wednesday.

A situation where people move back and forth from private insurance to Medicaid hasn’t existed before, said Andy Allison, state Medicaid director.

Officials fear thousands of Arkansans — including many who work sporadically — will be left in limbo.

“There will be a dramatic increase in the number of individuals who go from one type of coverage to another,” Allison told Senate and House committees on insurance and commerce at a Black Legislative Caucus conference. “How do we provide continuity?”

Insurance Commissioner Jay Bradford said his agency will seek lawmakers’ approval of a $1.2 million contract to study how to coordinate Medicaid and exchange coverage at an Arkansas Legislative Council meeting on Friday.

Insurance-exchange officials have said that certain groups of people who work seasonally or are vulnerable to layoffs are likely to be covered part of the year by Medicaid — if it’s expanded — and part of the year with private insurance under the exchange.

People earning 138 percent of the poverty level will be covered by Medicaid if the state opts to participate in the federally aided expansion. If those workers start to earn more than $15,415, then they would buy federally subsidized insurance on the exchange.

It is unclear how many people would switch periodically between private insurance and the state’s $4.6 billion Medicaid program, which covers about 780,000. The insurance exchange’s planning manager, Cynthia Crone, said it might be as high as 60 percent of participants in the programs in poorer states such as Arkansas.

So far, Arkansas has received almost $9 million in federal grants to plan the exchange. About 326,000 Arkansans are expected to sign up for private insurance plans offered on the exchange and those with incomes between 100 percent and 400 percent of the poverty level will receive federal subsidies. More than 500,000 state residents are uninsured, Crone said.

The state will learn if it will receive an additional $18.6 million federal planning grant in the next few days. On Monday, Bradford told the Arkansas Democrat-Gazette that he would probably wait to seek legislative approval for that grant until after the Nov. 6 election. He said he thought the politics surrounding President Barack Obama’s healthcare law would have cooled by then, making it easier for lawmakers to accept the federal money.

On Wednesday, Bradford said that lawmakers up for election had been unfairly tarred in mailings that claimed they voted for the Patient Protection and Affordable Care Act. Americans for Prosperity, a conservative group, has targeted some Democrats with such mailings.

“Not a member in our Legislature voted for Obamacare, they voted for the Insurance Department’s budget,” Bradford said.

Medicaid expansion also was discussed.

Dr. Creshelle Nash, a professor at the Fay Boozman School of Public Health at the University of Arkansas for Medical Sciences, said her analysis of data indicates that expansion could “conservatively” save 500 lives.

Currently, the state provides 30 cents of every Medicaid dollar. The federal government covers the rest. If three-quarters of the Legislature votes to expand the rolls as allowed under the Affordable Care Act, the federal government will pay the full cost of expansion until 2017. By 2020, the state will pay 10 percent of the costs. The federal government would pay $900 million a year for expansion.

The state has estimated it will save $372 million between 2014 and 2021 through increased tax revenue and savings, including a reduction in the need for state-funded emergency-room care for the uninsured.

Nash also said minoritygroup communities need to be effectively informed about expansion.

Idonia Trotter, executive director of the Arkansas Minority Health Commission, said her group has been doing just that, recently drawing 120 people to a Tuesday evening meeting in Stuttgart.

“People are hungry for information,” she said. Her state agency has endorsed expansion. She said she doesn’t consider it improper for a state agency to take a position on the issue since “there is no greater charge that our agency has” than to improve the health of the state’s population.

Some audience members said they were concerned that if Medicaid expanded, there wouldn’t be enough providers willing to accept the newly enrolled.

Bradford said that — taken together — expansion and the exchange would bring about $2 billion in federal aid to the state.

“Providers will follow the money,” he said.

No Republican lawmakers spoke during the session.

Rep. Reginald Murdock, D-Marianna, said it’s important for lawmakers to closely monitor the details of the exchange and possible Medicaid expansion to protect the interests of their constituents.

“As we get into this big old pie — $2 billion — that’s coming into our communities, I want to make sure that we pay attention, that we don’t get caught at the end of the day, deep in the Delta, and our constituents are not the ones who get the best service.”

Front Section, Pages 1 on 09/27/2012

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