Proposed changes to Arkansas' expanded Medicaid program won't require an adjustment in the cost cap for the program, the state Department of Human Services said in a notice published this week.
In the notice, posted on the state Medicaid website, the department also said it hopes to eliminate retroactive coverage for enrollees, beginning July 1, without having to meet conditions set out in the terms of the original Arkansas Works waiver, granted by former President Barack Obama's administration in December.
A draft of the request to amend the Arkansas Works waiver will be published today, according to the notice.
The requested waiver amendments would implement changes to the state's expanded Medicaid program that were proposed by Gov. Asa Hutchinson and endorsed by the state Legislature during a special session earlier this month.
The changes include removing about 60,000 Arkansans from the program, starting Jan. 1, by limiting eligibility to adults with incomes at 100 percent of the poverty level, instead of 138 percent of the poverty level.
The state also would impose a work requirement on many of the 270,000 Arkansans who would remain covered by the program. It also would eliminate a program that can use Medicaid funds to subsidize job-based coverage for small-business employees.
Only one business, Shire Post Mint in Springdale, is participating in that program, and it receives assistance for just one of its employees, Human Services Department spokesman Brandi Hinkle said Thursday.
The state will accept comments on the draft waiver request at two public hearings. The first will be at 5:30 p.m. on Thursday in the Darragh Center Auditorium of the Main Library at 100 S. Rock St. in Little Rock.
The second will be at 5:30 p.m. on June 6 in Arkansas State University's Cooper Alumni Center at 2600 Alumni Blvd. in Jonesboro.
The Human Services Department also will accept written comments through June 18.
Under the 2010 Patient Protection and Affordable Care Act, the federal government paid the full cost of coverage for states, such as Arkansas, that expanded Medicaid through the end of last year.
Starting in January, states became responsible for 5 percent of the cost. The health care law calls for the states' share to rise each year until it reaches 10 percent in 2020.
Under the Arkansas Works waiver, Arkansas will owe additional money if the program's cost over five years exceeds a cap that will be calculated based on monthly per-enrollee cost targets listed in the waiver's terms.
From January through March, Arkansas' per-enrollee cost was about $37 below the monthly limit of $570.50 for 2017. In the notice, dated Wednesday, the Human Services Department said it won't request an adjustment in the cost limits, which automatically increase 4.7 percent each year.
"The State expects that, over the life of the Demonstration, covering Arkansas Works enrollees will be comprable to what the costs would have been for covering the same group of Arkansas adults using traditional Medicaid," the notice says. "The State does not anticipate that the amendments to the Demonstration will affect its current waiver trend rate or per capita cost estimates."
Building on changes that took effect Jan. 1, when the expanded Medicaid program became known as Arkansas Works, the waiver amendments, if approved by President Donald Trump's administration, would allow the state to implement changes that the Obama administration rejected.
The changes the Obama administration did approve included charging premiums of $13 a month to enrollees with incomes above the poverty level, creating the small-business program, and referring enrollees to job training and placement services.
Hutchinson also wanted a waiver from a requirement for the state to reimburse enrollees for medical expenses incurred up to 90 days before they are approved for coverage. He proposed having coverage start on the first day of the month when an application is submitted.
The federal Centers for Medicare and Medicaid Services said it would grant that request if Arkansas met certain conditions.
Those included eliminating the state's backlog of overdue Medicaid applications, providing up to 90 days of coverage for foreigners who have not provided documents on their legal status, and covering patients who have received an initial eligibility determination from hospitals.
Human Services Department officials say they have eliminated the backlog, and a regulation providing the coverage for foreigners took effect Feb. 1.
But officials with the Arkansas Hospital Association said the state has not yet established a "hospital presumptive eligibility" program, required under the Affordable Care Act, that would allow hospitals to make preliminary Medicaid determinations.
In a June 13 letter, association Chief Executive Officer Bo Ryall said eliminating the 90 days of retroactive coverage, without implementing hospital presumptive eligibility, could result in some Arkansans "saddled with large amounts of health care debt that could have been avoided."
Paul Cunningham, the association's executive vice president, and Jodiane Tritt, its vice president of governmental relations, said Thursday that the association still has the same concern.
Tritt added that making a preliminary Medicaid determination helps hospital officials "know the rules of the game," in terms of types of care that will be covered.
The Human Services Department's Hinkle said she didn't have any additional information Thursday on the proposed amendments.
Before the expansion, which took effect in 2014, Arkansas' Medicaid program covered poor people who are elderly or disabled, children from low-income families, and parents with incomes up to 17 percent of the poverty level.
Nondisabled, childless adults under 65 were not eligible, regardless of income.
Under the state's so-called private option, most enrollees in the expanded Medicaid program receive coverage through private plans on the state's health insurance exchange, with the Medicaid program paying the premium and providing additional subsidies that reduce or eliminate the enrollees' out-of-pocket charges for medical care.
Metro on 05/19/2017