Facing opposition from providers, recipients and some lawmakers, state officials on Tuesday agreed to temporarily withdraw a proposal limiting in-home Medicaid assistance to the elderly and disabled.
At a meeting of the Legislative Council's Administrative Rules and Regulations Subcommittee, Department of Human Services officials announced that they would meet with providers to explore changes to the proposal affecting the 8,800 people served by the ARChoices program.
The department will then take the proposal with any changes back to the subcommittee at a special meeting Thursday.
Kelley Linck, the department's chief of legislative and governmental affairs, said officials need time to study the potential impact of any changes, including the effect on the program's cost.
"I can't, quote, work a deal or get something resolved on that today," Linck told lawmakers. "Will we sit down with them right after this meeting? Glad to. I'm glad to try to find a path forward."
Rep. Kim Hammer, R-Benton and a chairman of the subcommittee, noted that the panel heard from providers and recipients on Tuesday and won't take any more comments from the public at Thursday's meeting.
The decision to pull the proposal came after Human Services Department officials announced that they had reached an agreement with providers on a 22 percent rate cut to assisted living facilities that is also part of the proposal.
Linck said the department will collect more information on the facilities' costs and commission a new study by its actuarial consultant, Seattle-based Milliman, to determine whether the reduction should be modified.
The department will also phase in the reduction over a two-year period instead of one year, as it had agreed to do earlier.
The rate cut and ARChoices changes are part of the state's efforts to slow the growth of Medicaid spending by enough to save $835 million from the fiscal year that started July 1, 2017, through fiscal 2021.
Gov. Asa Hutchinson set the goal, which was endorsed by a legislative task force, in 2015 as a way of helping to pay the cost of expanding Medicaid to adults with incomes of up to 138 percent of the poverty level.
As its contribution to the plan, the Arkansas Health Care Association, which represents nursing homes, agreed to help craft measures reducing spending on nursing homes, assisted living facilities and in-home care by $250 million over the same period.
Some critics of the proposal have complained about the association's involvement in crafting the rules that they contend will benefit nursing homes at the expense of other providers.
Department officials have said the changes will control costs while giving it more flexibility to tailor the benefits for each enrollee.
"Every day we have more and more seniors who need these services, and so we want to make sure the program stays fiscally sustainable so we can continue to help all those folks," Mark White, deputy director of the department's Aging, Adult and Behavioral Health Services Division, said at the meeting Tuesday.
Hutchinson stopped by the meeting, watching from the back of the room at the Multi-Agency Complex near the Capitol and shaking hands with members of the audience.
"He wanted to go down there and show that this was important, and he went there to check in with his legislative director to see how things were going and just to get a feel for the hearing overall," Hutchinson's spokesman, J.R. Davis, said.
After the Human Services Department proposal was pulled from the agenda, the panel approved a request by Hammer to direct legislative staff to seek a contract with The Stephen Group of Manchester, N.H., to review it. The consulting firm worked with the Health Reform Legislative Task Force in 2015 and 2016 on recommendations to slow the growth of state's Medicaid spending.
"Given the magnitude of the impact this decision has, I think we need to go back to the original source," Hammer said after the meeting.
ARChoices provides help with daily living tasks and other needs for low-income people with disabilities severe enough to qualify for placement in a nursing home.
The Human Services Department's proposal, which would start Jan. 1, would cap the program's benefits at $30,000 a year for recipients with the greatest needs -- those who require total or extensive assistance with moving from one place to another, eating and using the bathroom.
Enrollees requiring assistance with only two of those activities would be eligible for up to $20,000 of care. The annual cost for those with less extensive needs would be capped at $5,000 each.
Enrollees who are currently receiving more than $30,000 would be allowed to continue receiving their current level of care in 2019 and 95 percent of that amount in 2020.
The state would also scrap an algorithm currently used to assign recipients to "resource utilization groups" based on their medical diagnoses and answers to questions about their needs.
Instead, the hours would be calculated based on an estimate of how many minutes of assistance the recipient needs with tasks such as dressing, eating and bathing.
The current system for allocating benefits has been the subject of lawsuits by Jonesboro-based Legal Aid of Arkansas, which argues that the formula caused widespread reductions in the hours of in-home assistance.
White said Tuesday that the change is needed in part because the company that provides the software platform for the current system doesn't want to provide the service after Jan. 1.
Legal Aid attorney Kevin De Liban said the proposed cost caps would leave many recipients without as much care as they need.
Raising the cap for the most severely disabled recipients to $36,000 or $39,000 would fill the gap while increasing the annual cost by $1.3 million to $2.5 million, he said.
That would still leave the state with some of the $7.8 million in taxpayer savings the department estimated the proposal would generate in the first fiscal year it is in effect, starting July 1.
Robert Ford, 53, of North Little Rock, who was partially paralyzed in a car accident in 1999, told legislators the program provides him with eight hours a day of care, helping to keep him out of a nursing home.
He asked lawmakers to put themselves in his shoes.
"Close your eyes," he said. "Would you want to be in a nursing home?"
Metro on 12/19/2018