In a presentation to Arkansas legislators Wednesday, New Hampshire-based consultants The Stephen Group recommended revising the private option, the state's expanded Medicaid program that uses federal dollars to subsidize private health insurance for up to 250,000 Arkansans.
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The consultant's proposed Transitional Health Insurance Program (T-HIP) would base its success on moving "beneficiaries up a career ladder towards independence."
Key recommendations:
• Encourage Medicaid-eligible individuals to keep employer-sponsored insurance by using Medicaid funds to offer wraparound coverage to help pay premiums, deductibles and copayments.
• Require able-bodied recipients who choose not to work but have substantial assets, such as homes valued over $200,000 or cash-equivalent assets of $50,000 or more, to pay a set amount to participate in the program.
• Require unemployed beneficiaries to participate in job training or find work or face having to pay maximum allowable premiums and copayments.
• Establish publicly available health scorecards and a rating system that provide statistics that help focus wellness and prevention efforts.
• Require insurers to offer education on the appropriate and proper use of health care services, especially hospital emergency rooms, primary-care physicians and treatment of chronic conditions.
• Require certification for the medically frail and coordinated care for those individuals.
• Offer a one-time payment per employee to employers to help defray the cost of providing employer-sponsored health insurance.
• Require beneficiaries to sign a membership agreement that requires a visit to a primary-care physician within the first six months and participation in the work requirement or face financial penalties.
• Create a wellness report card for each beneficiary that tracks critical health criteria to ensure that participants live up to their membership agreement.
• Offer vision and dental benefits, which aren't offered under the private option but are part of traditional Medicaid.
• Improve accountability by locking out beneficiaries who fail to pay their premium or cost share for high assets or who have failed to meet the terms of their membership agreement.
• Require copayments to encourage appropriate use of services.
A Section on 10/08/2015