Arkansas’ Medicaid program will reimburse insurance companies for some of the medical costs associated with an unknown number of women who were pregnant when they enrolled in the state’s so-called private option, a spokesman for the Arkansas Department of Human Services said.
The women were among more than 63,000 recipients of the Supplemental Nutrition Assistance Program, also known as food stamps, who enrolled after the Human Services Department determined they had incomes low enough to make them eligible for coverage under the state’s expanded Medicaid program, including the private option.
The department sent notices to food-stamp recipients in September that they could sign and return if they wanted coverage. Because of an oversight, however, the notices did not ask the recipients if they were pregnant.
Women who are pregnant at the time they apply for coverage are not eligible for the private option, Human Services Department spokesman Amy Webb said.
An older, fee-for-service Medicaid program covers expenses related to pregnancy and childbirth, including health conditions that could complicate a pregnancy, for women with incomes of up to 200 percent of the poverty level.
The private option allows eligible recipients - adults with incomes of up to 138 percent of the poverty level - to sign up for a private plan on the health insurance exchange and have their premiums paid by Medicaid.
Under the federal healthcare overhaul law - the Patient Protection and Af-fordable Care Act - women who qualify for the older program are not eligible for the expanded Medicaid program, including the private option in Arkansas.
“The SNAP data does not include pregnancy status so we should have asked that question at the time,” Webb said in an email.
She said department officials don’t yet know how many pregnant women were enrolled in the private option.
To avoid a disruption in the women’s coverage, the U.S. Department of Health and Human Services’ Centers for Medicaid and Medicare Services has agreed to allow the women to stay in the private option, with the federal government paying the full cost of their premiums as it does for other private-option enrollees.
The state Medicaid program, meanwhile, will pay the insurance companies $4,500 for each child born to the women through June 30.
Medicaid officials don’t expect the payments to come from state tax dollars, Webb said.
“Since these women are in the private option, we expect the payments will be federal funding unless the feds tell us otherwise,” Webb said.
A notice from state Medicaid Director Andy Allison to the insurance companies indicated that the payments would be made in two installments: one at the end of March and one at the end of June.
Webb said the first payment had not yet been made as of Thursday because officials are “allowing lag time for claims to come in.”
If the federal government covers the full cost of the women’s coverage, it would mean a savings to the state. Under the traditional Medicaid program for pregnant women, the state pays about 30 percent of the costs, with the federal government covering the rest.
As of Wednesday, 8,330 women were in that program, Webb said.
The expansion of the state’s Medicaid program, authorized by the federal health-overhaul law and approved by the Legislature last year, extended eligibility to adults with incomes of up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.
Most of those who are eligible can receive coverage through private plans, although those with exceptional health needs are assigned to the traditional Medicaid program.
The application for Medicaid assistance asks whether the applicant is pregnant, Webb said. Pregnant applicants with incomes below 200 percent of the poverty level are referred to the program for pregnant women.
The program covers medical expenses for 60 days after the child is born. After that, the women can apply for coverage under the expanded Medicaid program, including the private option.
Women who become pregnant while enrolled in the private option can continue receiving coverage through the private option or switch to the program for pregnant women, Webb said.
Sen. David Sanders, R-Little Rock, a sponsor of the legislation creating the private option, called the payments to the insurance companies a reasonable solution.
“It’s certainly the expectation that the carriers had” that pregnant women would not be allowed to enroll in the private option, he said.
Under the terms of the waiver authorizing the private option, the federal government will pay the full cost of the program through 2016, as long as the cost of the private option doesn’t exceed specified caps.
The monthly cap for 2014 is $477.63 per person. That limit rises to $500.08 in 2015 and$523.58 in 2016.
Webb said the supplemental payments for pregnant women will be included in calculating the cost of the private option, but the state should be allowed to adjust the spending caps, if necessary, to reflect the payments.
The waiver’s terms allow the state to request that the caps be adjusted if it has information indicating that it “may underestimate the actual costs of medical assistance for the new adult group.”
Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield, one of four companies offering plans on the insurance exchange, said the companies took the issue to the attention of Medicaid officials after receiving claims related to pregnancies.
The payments, she said, are “better than not addressing [the issue] at all.”
Asked if he was satisfied with the solution, Mike Stock, chief executive of QualChoice Health Insurance, which also is offering plans on the exchange, responded, “I suppose so.”
Greenwood added, “I think it’s a one-year event, and there will be mechanisms in place for the next round of enrollment so those things don’t occur.”
Arkansas, Pages 11 on 04/04/2014