Medicaid push on to add Marshallese, other kids

Marshallese children living in Arkansas would become eligible for coverage through the state's' Medicaid program under regulations proposed by the state Department of Human Services.

The proposal, which will be submitted for approval to the federal government and the state Legislative Council, would also eliminate a requirement that other children who are legal immigrants live in the country five years before becoming eligible for Medicaid.

The changes would take effect Jan. 1, Human Services Department spokesman Brandi Hinkle said.

Laura Kellams, Northwest Arkansas director for Arkansas Advocates for Children and Families, said the change would extend coverage to about 2,000 Marshallese children from low-income families, as well as a smaller number of non-Marshallese immigrants who have been in the country for fewer than five years.

Illegal aliens are not eligible for Medicaid.

A 1986 compact allows citizens of the Marshall Islands unrestricted travel to the United States, but they were made ineligible for federally supported Medicaid coverage by the welfare overhaul law signed by President Bill Clinton in 1996.

Most other legal immigrants who would otherwise qualify for Medicaid become eligible after living in the United States for five years.

A 2009 federal law gave states the option to extend Medicaid coverage to children from the Marshall Islands and other nations covered under such compacts.

Thirty-one other states and the District of Columbia have expanded coverage as allowed under the 2009 law, Kellams said. Another state, Nevada, is also in the process of implementing the change, she said.

"Our argument is that it's a matter of fairness" to extend eligibility to the Marshallese, since immigrants from other countries can eventually qualify for Medicaid, Kellams said.

According to guidance issued to states in 2010 by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services, states that expand coverage for immigrant children under the 2009 law must also eliminate waiting periods.

Gov. Asa Hutchinson supports the proposal, spokesman Kendall Marr said.

Under the 2010 Patient Protection and Affordable Care Act, the federal government in 2015 began covering the full cost of coverage for children under the state's Arkids First Medicaid program.

Previously, the federal government had paid about 80 percent of the cost. In the fiscal year that ended June 30, 2016, the state Medicaid program spent $1.7 billion on coverage for just over 500,000 children, according to a Human Services Department report.

The coverage is available to children in families with incomes of up to 216 percent of the poverty level: for example, $53,136 for a family of four.

Marr said the enhanced federal funding made the expansion more financially feasible for the state. Recent improvements to the state's computerized enrollment and eligibility system for Medicaid also made the change easier to implement, he said.

Kellams said the advocacy of Rep. Jeff Williams, R-Springdale, whose district is home to a large Marshallese population, also helped spur the state to move forward.

During this year's legislative session, Williams and Sen. Lance Eads, also a Springdale Republican, sponsored a resolution, passed by lawmakers, that called on Hutchinson to pursue the coverage expansion.

Hutchinson signed the resolution at a ceremony in March attended by Gerald Zackios, the islands' ambassador to the United States.

"We're very proud of the relationship that we have," Hutchinson said at the ceremony. "You're so much a part of the fabric of the community of Northwest Arkansas."

Williams, who was elected to his first term last year, said Tuesday that the issue is "important for a large portion of my constituents."

"This is just correcting a wrong that was done some 20 years ago," Williams said. "It's just about time we get this straightened out and corrected."

Northwest Arkansas is home to an estimated 8,000 to 12,000 Marshallese, the largest population of the islanders in the continental United States.

Currently, the state Medicaid program pays for expenses related to pregnancy and childbirth for Marshallese women with incomes of up to 214 percent of poverty. Marshallese adults are otherwise barred from coverage under the 1996 welfare overhaul. That wouldn't change under the proposed regulations.

Marshallese adults and children are eligible for tax-credit subsidies provided under the Affordable Care Act to help buy coverage offered on the state's health insurance exchange, which is accessible through the federal site, healthcare.gov.

The subsidies are available to people who don't qualify for Medicaid or other government health programs and have incomes of 100-400 percent of the federal poverty level.

The United States took control of the islands from Japan during World War II and tested nuclear weapons there between 1947 and 1962. The Compact of Free Association, which went into effect in 1986, gave the islands independence while also allowing Marshallese citizens to live and work in the United States without visas.

The Human Services Department published the proposed regulations on the state Medicaid program website last week. The department is accepting written comments on the proposed changes through Aug. 21.

Metro on 07/26/2017