QualChoice’s private-option cap of 1,280 self-imposed, state says

The state Department of Human Services stopped allowing people who qualify for the so-called private-option Medicaid program to enroll in plans offered by QualChoice Health Insurance in early November, about a month after enrollment started, a spokesman for the department said.

Enrollment in the Qual-Choice plans through the private option was capped at 1,280, department spokesman Amy Webb said.

Since the cap was reached, QualChoice plans have not been among the choices available to potential private-option enrollees through a state website insureark.org, and the department has not assigned any enrollees to the QualChoice plans.

The list of plans offered through insureark.org is generally only visible to those who have been approved for Medicaid coverage through the private option and have been issued an identification number.

QualChoice Chief Executive Officer Mike Stock said the limit was in response to a request the company made to the Insurance Department last summer because of the company’s discussions with Denver-based Catholic Health Initiatives.

The companies announced Wednesday that a subsidiary of Catholic Health Initiatives, which owns St. Vincent Health System, had reached an agreement to buy QualChoice.

Stock said he didn’t know what changes Catholic Health Initiatives might want to make after acquiring QualChoice and wanted to keep enrollment low to minimize any difficulties with the transition.

“It’s just easier to have less volume,” Stock said.

Stock said the company requested that its enrollment through the federal exchange, where people who don’t qualify for Medicaid can apply for tax subsidies, and private option be limited to 10,000.

Enrollment in the company’s plans through the private option was stopped as a way of keeping the overall total under 10,000, he said.

Enrollment in the company’s plans among those who don’t qualify for Medicaid has continued through the federal enrollment portal, healthcare. gov, he said.

But because enrollment among those who don’t qualify for Medicaid has been slow, QualChoice’s overall enrollment is less than 3,000 - well below the 10,000-person cap.

The Human Services Department released figures on the enrollment in the private option showing totals by insurance company in November, January and February, but the information did not mention the QualChoice enrollment cap.

Webb said she told a reporter about the cap in response to a question about why Qual-Choice’s enrollment was low. She said she didn’t remember which reporter.

“It wasn’t something we were hiding,” Webb said.

Sen. Jonathan Dismang, R-Searcy, a sponsor of the legislation authorizing the expansion of Medicaid through the private option, said he didn’t know about the cap. He said he planned to inquire about it.

“For a while now we’ve been talking about the numbers of carriers that are participating,” Dismang said. “It’s very frustrating.”

Another architect of the private option, Sen. David Sanders, R-Little Rock, said he knew about the overall cap but didn’t realize the private-option enrollment was stopped at such a low number.

“I’m going to have to get some clarification,” Sanders said.

Stock said he’s hoping the merger with Catholic Health Initiatives will be approved by the Insurance Department within 30 days. After that, he said, he will request that the cap be lifted.

He added that the company will likely apply next year to offer plans in each of the state’s seven coverage regions. This year, the company’s plans are not available in the southwest and southeast regions.

Under the private option, most adults with incomes of up to 138 percent of the poverty level - a single adult with an income of up to $16,105, for instance - can enroll in a plan on the exchange and have the premiums paid by Medicaid.

Tax-credit subsidies are available to those who don’t qualify for Medicaid but have incomes of less than 400 percent of the poverty level - for example, $45,960 for an individual, or $94,200 for a family of four.

Enrollment began Oct. 1 for coverage that started Jan. 1. For most people who don’t qualify for Medicaid, enrollment for coverage starting in 2014 ended Monday. People who qualify for Medicaid can enroll throughout the year.

Arkansas Blue Cross and Blue Shield, the national Blue Cross and Blue Shield Association and St. Louis-based Centene Corp. are also offering plans on the insurance exchange in Arkansas.

The suspension of enrollment in QualChoice plans came in early November after 1,000 food-stamp recipients were automatically assigned to the plans. The food-stamp recipients had indicated they wanted coverage but failed to choose a plan on their own within 12 days.

Those assignments brought QualChoice’s enrollment total for the private option to 1,280. As of Feb. 6, latest date for which enrollment by insurance company has been released, the total had fallen to 1,220.

Insurance Commissioner Jay Bradford confirmed that enrollment in QualChoice plans was slowed down as a result of the merger talks, but said he didn’t have further details Wednesday afternoon.

“It was unfortunate timing, but now it’s behind us,” Bradford said. If the merger is approved he said, “I would expect it would be a new day for that entity.”