Medicaid decision next year?

LITTLE ROCK — Republican lawmakers are talking about delaying a decision on Medicaid expansion until next year as they absorb an avalanche of new information regarding options to full expansion, and a reduction in the expected funding shortfall in the state program.

House Speaker Davy Carter said Thursday that he isn’t wedded to any deadline on enlarging the rolls of the $5 billion program.

Gov. Mike Beebe still wants the issue decided during the current session, said spokesman Matt DeCample.

“Our plan and hope is still to have it addressed during regular session. That’s why we’re here now,” DeCample said.

Beebe and Carter met Wednesday and discussed expansion, but pushing the expansion debate to the fiscal session didn’t come up, DeCample said. The governor’s office wasn’t aware of any such talk until contacted by the Arkansas Democrat-Gazette later Wednesday, he said.

Talk swirled in the hallways of the Capitol by midweek that Carter, a Cabot Republican, had told lobbyists that the best time for debating expansion would be during the fiscal session in February 2014. Carter said any comments he made about the fiscal session had been misinterpreted.

“We’re just speculating, and people just infer that’s the plan,” he said. “If someone has misunderstood, I don’t know how to control that.”

Rep. John Burris, a Harrison Republican and the chairman of the House Public Health, Welfare and Labor Committee, said he sees an advantage to tackling expansion next year.Some House Democrats said they have been approached by Burris with such a scenario.

“What I’ve said is that we don’t even have to have a special session. We’re going to be back here in less than a year, and it’s only an appropriation bill, so it would be completely appropriate to address [in February 2014],” Burris said.

One of the knocks against holding a special session is the cost to taxpayers, Burris said.

Plus, legislators will have a better grasp of the data after the insurance exchange has had several months to enroll eligible consumers. The exchange is a marketplace for health coverage created by the federal Patient Protection and Affordable Care Act in 2010, which goes into effect in 2014. Enrollment on the exchange, which is not part of Medicaid, begins on Oct. 1, Burris said.

Carter said he’s been consistent about not being held to a timeline.

“I don’t know what the timeline is. I don’t want anybody to infer that because we don’t have the information today ... that there’s some set-in stone timetable out in the future. That’s just not the case,” said Carter. “I’m not thinking that way.”

In the four weeks since the legislative session began, the federal government has sent signals that it is open to considering some kind of partial expansion, he said.

The federal government also has agreed to look at allowing some of the estimated 250,000 Arkansans eligible for expanded Medicaid coverage to buy private insurance on the state’s health-insurance exchange, Carter said.

And the state Department of Human Services reported last week that the projected shortfall in the program has been halved in the past three months - from $138 million to $61 million - without a convincing explanation for the shrinkage, Carter said.

Medicaid now covers about 780,000 of the state’s poor, elderly and disabled as well as low-income children.

“There’s a lot of stuff that changed in a short period of time. It’s just responsible to wait and make sure we understand what the options are,” Carter said.

Come February 2014, Burris said, lawmakers will better understand the number of people whose income falls between 100 percent and 138 percent of the poverty line, or between $11,170 and $15,415. The federal government is considering a request by the state to allow Arkansans whose income is just above the poverty level to choose private insurance on the state’s exchange instead of Medicaid if the state fully expands the $5 billion program by 250,000.

The Department of Human Services has estimated that about 51,000 Arkansans earn between $11,170 and $15,415, but Burris said those estimates are rough.

“It’s really hard to quantify,” he said.

Once many of the state’s 500,000 or so uninsured people who are eligible buy insurance on the exchange, a clearer portrait will emerge of the higher earners in the group covered by expansion, Burris said.

Democrats say that waiting could cost the state money. The federal government has promised to fully fund expansion until 2017. After that, the state gradually assumes more of the fiscal burden. By 2020, Arkansas would be responsible for 10 percent of the costs.

“The longer we wait, the more we risk not being able to take full advantage of this funding and seeing our tax dollars go to other states instead,” DeCample said. Federal dollars will begin in January 2014 to fund Medicaid expansion in states that participate.

Rep. Reginald Murdock, a Marianna Democrat, doesn’t want to wait on expansion.

“I have all kinds of angst with that,” said Murdock, the top Democrat on the House Public Health panel.

When Republicans killed state control of the insurance exchange in 2011, Murdock said, it hurt the state.

“We waited then at the insistence of Republicans. Yesterday, on the steel mill [Amendment 82 discussion in House], you heard wait. I think waiting could prove to be a problem again,” he said.

Expanding Medicaid is “pro-health, pro-economy and pro-Arkansas,” said Rep. Darrin Williams, a Little Rock Democrat. Delaying a decision would be “very unwise,” he said.

For now, Burris said, the talk about delaying Medicaid expansion until next year is just that - talk.

“It’s not a plan at all,” Burris said. “I want to wait, and waiting doesn’t have to mean a special session.”

Other Republicans also seem inclined to at least entertain the idea of wrestling with expansion next year.

“There’s no timeline, we don’t have to be rushing to do anything,” said Sen. Cecile Bledsoe, a Rogers Republican and chairman of the Senate Public Health, Welfare and Labor Committee. Beebe can decide to call a special session later this year, she said, or the issue could wait until 2014.

“I would just look to the governor. If he wants to wait until February 2014, that’s a good place for it,” she said.