Arkansas has formally asked to extend beyond 2016 the federal waiver authorizing the private option Medicaid program, a spokesman for the state Department of Human Services said Monday.
Granted in 2013, the waiver issued by the Centers for Medicare and Medicaid Services allowed Arkansas to expand its Medicaid program primarily by using federal dollars to buy health coverage for enrollees on the state's federally run insurance exchange.
Almost 199,000 Arkansans were covered by the program as of Oct. 15, the most recent figures available.
The waiver's terms required Arkansas to apply by last Thursday for an extension of the Dec. 31, 2016, expiration date or submit a "transition and phase-out plan."
The extension request, submitted on the day of the deadline, notes that state officials expect to seek amendments to the waiver this spring to enact changes such as those proposed by Gov. Asa Hutchinson.
Those changes include charging premiums to enrollees with incomes above the poverty level, subsidizing coverage through employer plans for those with access to job-based coverage, and requiring referrals to job-training programs for unemployed enrollees.
In a letter dated Dec. 29 to U.S. Health and Human Services Secretary Sylvia Burwell, Hutchinson said such changes would support the state's goal of providing coverage that is "affordable, competitive, market-based and based on the principles of choice, competition, improved quality of care and consumer responsibility."
A legislative task force last month endorsed Hutchinson's plan to seek federal approval for the changes.
No one spoke at two public hearings held last month on the proposed extension, nor did anyone submit written comments, according to the written extension request.
Hutchinson has said he plans to discuss possible changes with Burwell this month.
The final details of the revamped program would then go to the Health Reform Legislative Task Force and the full Legislature during a special session that Hutchinson said he plans to call in April.
The proposal would then be sent to the Centers for Medicare and Medicaid Services.
Approved by the Legislature in 2013, the expansion of the state's Medicaid program extended coverage to adults with incomes of up to 138 percent of the poverty level: $16,243 for an individual, for instance, or $33,465 for a family of four.
Other changes Hutchinson has proposed to the private option include:
• Offering enhanced benefits, such as vision coverage, for enrollees who meet certain program requirements.
• No longer providing reimbursement for medical expenses incurred up to 90 days before an enrollee applies for coverage. Instead, the coverage should start on the day of enrollment, Hutchinson said.
• Excluding from coverage or charging higher premiums to Arkansans who own substantial assets, such as a house worth $200,000 or more or cash-equivalent assets of at least $50,000.
The federal government is paying the full cost of the private option, but Arkansas will start paying part of the cost in 2017. The state's share will start at 5 percent and increase each year until it reaches 10 percent in 2020.
To cover the state's share, Hutchinson has said he wants to trim the state's spending on the traditional Medicaid program by at least $50 million a year.
Because the federal government pays about 70 percent of the cost of the traditional Medicaid program, reducing state spending by $50 million annually means reducing overall Medicaid spending by about $167 million a year.
At a meeting last month, the task force endorsed Hutchinson's goal to curb the growth of spending in the Medicaid program by $167 million a year for five years.
Hutchinson said he wants the reductions to come from spending on patients with expensive medical needs, such as nursing-home residents, the developmentally disabled and the mentally ill.
A Section on 01/05/2016