CONWAY -- In proposing changes to Arkansas' Medicaid expansion program, Gov. Asa Hutchinson said Tuesday evening that he wants to encourage work and personal responsibility while keeping the needs of the state's poorest residents in mind.
"We're not trying to create hardships," Hutchinson said at what he described as a "town hall" meeting at Central Baptist College in Conway attended by about 100 people. "We're trying to move people up the economic ladder."
The Arkansas Legislature will meet in a special sessionthat begins April 6 to consider changes to the expanded Medicaid program. That program covers about 267,000 low-income Arkansans. The lawmakers also will be considering changes to the traditional fee-for-service program covering children from low-income families and poor people who are elderly or disabled.
Authorized by the 2010 Patient Protection and Affordable Care Act and approved by the Legislature in 2013, the expansion extended coverage to Arkansans with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four.
Most of those enrolled are covered by private plans purchased with Medicaid funds under the so-called private option.
Hutchinson has said he wants to make changes to the private option to encourage enrollees to stay employed and take responsibility for their health coverage.
Those changes include charging premiums of about $19 a month to enrollees with incomes of at least the poverty level, referring unemployed enrollees to job-training programs and using Medicaid funds to subsidize job-based coverage for enrollees who are employed.
The revamped program would be called Arkansas Works.
Hutchinson's plan does not propose charging premiums to the 80 percent of enrollees who have incomes below the poverty level and who currently do not pay premiums or other charges for medical care.
Currently, private option enrollees with incomes above the poverty level must make small copayments when they receive services unless they contribute up to $15 monthly to "independence accounts."
Under a separate bill, Hutchinson said he will propose hiring managed-care companies to provide services for the disabled and mentally ill as part of a plan to curb the growth of spending in the traditional Medicaid program.
He said the bill will include a "bill of rights," similar to one in place in North Carolina, with protections for both recipients and health care providers affected by managed care.
The legislation will bar the managed-care companies from reducing providers rates -- beyond those now in place under the fee-for-service Medicaid program -- without their consent, he said.
The restrictions should give providers and recipients "the confidence that [the Medicaid program is] going to be properly managed," Hutchinson said after the meeting.
He said savings from the traditional Medicaid program will help the state pay its share of the cost of the expanded Medicaid program, which will start at 5 percent next year and increase to a maximum of 10 percent in 2020, and also reduce the number of people with developmental disabilities who are on a waiting list for home-based services, such as help with daily living tasks.
Loretta Cochran of Pottsville, whose 14-year-old son is one of the 3,000 Arkansans on the waiting list, said she would like to see the list reduced but is afraid that managed-care companies will cut benefits to recipients.
She told Hutchinson that she's also concerned that the Arkansas Works proposal will make life more difficult for people earning minimum wage.
"We're putting up all kinds of roadblocks for them to continue to get health care because we think they're lazy," Cochran said. "They're not."
A professor at Arkansas Tech University in Russellville, she said she's helped several of her students sign up for coverage under the private option.
"These are kids working two or three jobs because the state of Arkansas doesn't provide financial aid to help pay for their higher education," Cochran said.
Hutchinson noted later in the meeting that he had dropped an idea to charge premiums to private-option enrollees with incomes below the poverty level.
For those with higher incomes, he wants the program to waive premiums if the enrollees receive checkups or meet other criteria for healthy behavior.
People who contribute toward the cost of their care "take pride in the fact that they're participating," he added.
Continuing the expanded Medicaid program is, in part, a matter of fairness, Hutchinson said. He noted that, if the state ended its Medicaid expansion, many people earning just below the poverty level wouldn't qualify for any financial assistance.
Tax-credit subsidies through the federal health exchange would be available for those with incomes of between 100 and 400 percent of the poverty level but would not be available to those with lower incomes.
"I do not feel right as a governor to say we're going to be in a state that willingly cuts off those at a lower income, but we're going to continue to subsidize the higher income levels," Hutchinson said.
State Rep. David Meeks, R-Conway, who was one of several legislators in attendance, said after the meeting that he still opposes Medicaid expansion because he thinks it would be unsustainable for the state in the long run and that Arkansas could win federal approval for more significant changes than the ones Hutchinson is proposing.
He said he supports the managed-care proposal but wants to ensure the legislation includes adequate protections for providers and recipients.
"The devil is in the details," he said.
Metro on 03/23/2016