ARKids shift bid upsets legislators

Proposal to change First B program sprung on them by agency, they say

A proposal to offer additional benefits to children covered under the ARKids First B health insurance program and add it to the state's Children's Health Insurance Program plan stalled Tuesday after members of the Legislature's public health committees complained that they weren't told about the proposal earlier.

Lawmakers on the House's and the Senate's Public Health, Welfare and Labor committees also expressed frustration that state Department of Human Services officials couldn't provide more details about the change at the committees' hearing.

Rep. Kim Hammer, R-Benton, complained that "we're being handed a mess, and the kids are being used as a pawn, in my opinion."

"I think y'all three have been sent here and thrown under the bus," Hammer told Tami Harlan, assistant director of the department's Medical Services Division; Jean Hecker, a program administrator; and Anita Castleberry, utilization review manager for the division.

In response to Hammer's questions, Castleberry said that no one had instructed her to withhold information from legislators. She apologized for not briefing them sooner.

"This is truly a rookie mistake," Castleberry said.

Created under a federal Medicaid waiver in 1997, ARKids First B provides health insurance to children from families with incomes between 147 percent and 216 percent of the federal poverty level.

Children with lower family incomes are covered by the regular state Medicaid program for children, known as ARKids First A.

Compared with children in ARKids First A, those in ARKids First B receive fewer benefits, and their families must make co-payments: $10 for a doctor's visit, for instance.

As of June 30, about 312,000 children were covered by ARKids First A; about 65,000 were covered under ARKids First B.

In November 2013, the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services recommended that Arkansas make ARKids First B part of the state's plan for its Children's Health Insurance Program instead of renewing the ARKids First B waiver, which was set to expire Dec. 31, 2013, according to Human Services Department records.

Under the change, families would still have to make co-payments for children's medical care. But Harlan said the children would have coverage for additional services, including inpatient psychiatric care, orthodontics and occupational, physical and speech therapy.

According to the Human Services Department, the additional services would cost an estimated $24.3 million in the fiscal year that starts July 1 of next year, with the federal government paying all but $1.5 million of the cost.

The waiver was renewed last year for one additional year and is expected to expire Dec. 31, Harlan said. Federal officials have said they will not renew the waiver again, she said.

If the state-plan amendment isn't approved by the end of the year, the children covered by ARKids First B would lose coverage when the waiver expires. But Castleberry said the department could seek an extension of the waiver if legislators needed more time to review the proposed plan amendment.

Rep. Justin Harris, R-West Fork, said legislators were told children on ARKids First B would be moved onto the state's private option, which extended Medicaid coverage for adults through plans on the state's health insurance exchange.

"I feel like I've been snuckered," Harris said.

Castleberry said it's her understanding that the proposed change to ARKids First B "in no way changes what we were directed to do under the private-option legislation."

That legislation, Act 1498 of 2013, requires the Human Services Department to seek federal approval to move children covered by ARKids First B into plans on the state's health insurance exchange in 2015.

Sen. Cecile Bledsoe, R-Rogers and chairman of the Senate committee, asked the Human Services Department officials to bring the proposal back before the committees and to keep them updated on the waiver's status.

Human Services Department spokesman Kate Luck said after the hearing that department officials hadn't set a date on when they will take the proposal back to the committees.

Metro on 11/26/2014

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