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Outsider look at Medicaid in GOP plans

State data called insufficient by Charlie Frago | February 19, 2013 at 12:08 a.m.

— Republicans’ continued skepticism about the benefits of Medicaid expansion and the existing $5 billion program has prompted one effort, possibly two, to engage outside eyes to examine the program’s books, as well as Department of Human Services estimates.

Republican House Majority Leader Bruce Westerman said Monday that he plans to hire a consultant to provide fresh perspective on the entire Medicaid program, including the proposed expansion.

Democratic Gov. Mike Beebe discussed another idea for independent analysis of the benefits of expansion when he met with House and Senate leaders at the Governor’s Mansion last week, his spokesman said Monday. That idea, the scope of which is more limited, is still under consideration.

Westerman’s plan for a consultant “seems to be a separate and independent effort,” said Matt DeCample, Beebe’s spokesman.

Lawmakers have scrutinized the Medicaid program and its possible expansion since the U.S. Supreme Court ruled last year that it is optional under the federal Patient Protection and Affordable Care Act whether states enlarge their Medicaid programs.

As the independent-analysis ideas surfaced, a former state Medicaid director said he will lead a “long list” of expansion supporters who will openly make the case for adding as many as 250,000 Arkansans at the earnings levels of up to 138 percent of the federal poverty level to the Medicaid rolls.

Ray Hanley said the pro-expansion coalition would focus its efforts on “reaching out to people across the state, having a dialogue, to put a face on who will actually qualify: low income working adults who have health insurance.”

“At the end of the day, it will take bipartisan compromise. I’m sure there will be compromise,” said Hanley, who retired from the state Department of Human Services in early 2003 after serving three governors as Medicaid chief. Hanley is currently the chief executive officer and president for the Arkansas Foundation for Medical Care, a Little Rock nonprofit.

Westerman, R-Hot Springs, said he wants an outside consultant on board by the end of the week. Up to now, he said, lawmakers have relied on Department of Human Services data on expansion.

“We’ve had to rely on information that DHS provided to us,” Westerman told reporters at a Capitol news conference. “I think we’d like to have another set of eyes ... rather than just be told by DHS.”

Westerman said any consultant’s fee would be paid for by House and Senate budgets or the Bureau of Legislative Research.

During last week’s meeting at the Governor’s Mansion, Beebe suggested some consultants to Republicans who were there, his spokesman said.

That discussion involved a more “short-term” look at Department of Human Services projections for costs and savings under expansion, DeCample said.

“They’ve expressed continued concern about the estimates provided by DHS,” DeCample said. “The governor suggested [that] to them if it would give them added confidence in those numbers to bring in someone to go over the numbers and do an independent analysis.”

House Speaker Davy Carter, a Cabot Republican, said that Westerman’s consultant plan is a “different deal” than what was discussed at the meeting with Beebe. Carter attended that meeting with Senate President Pro Tempore Michael Lamoureux, a Russellville Republican, and other House and Senate leaders.

“That’s something different. [Beebe] gave me a couple of recommendations and the Bureau [of Legislative Research] has looked out to see who could do that kind of work,” Carter said.

Others at the meeting with Beebe last week were Republican Sens. Jonathan Dismang of Searcy, Cecile Bledsoe of Rogers and David Sanders of Little Rock and GOP House member John Burris of Harrison. Democrats included Sen. Larry Teague of Nashville and Darrin Williams of Little Rock, said DeCample and the lawmakers.

Republicans have questions about a Human Services Department’s prediction of roughly $630 million in savings by 2021 if the state expanded Medicaid. The savings would come from increased tax revenue, fewer dollars spent on uncompensated care to the uninsured and shifting some existing Medicaid recipients to the more generous federal coverage that arises under expansion.

Several GOP legislators also have questioned how the administration arrived at the estimate of the number of uninsured people who are between 17 percent of the federal poverty level and 138 percent, or individuals who earn between $1,899 and $15,415.

“We want to make sure we understand the assumptions they had,” Carter said.

Westerman said he’ll release more details on his consultant plan later this week, adding that his outside analysis wouldn’t be confined to expansion.

“This would be more to look at the overall Medicaid program. It would look at all aspects of Medicaid,” Westerman told the Arkansas Democrat-Gazette.

Westerman and Sanders have spearheaded a GOP effort to examine the existing Medicaid program, including a special audit released earlier this month that found $1.3 million in misspent money.

Beebe’s office has said many of the audit findings rehashed isolated mistakes that had already been released publicly. The special audit found no systemic problems in the program, which covers about 780,000 people, including pregnant women, the elderly, the disabled and low-income children, the governor’s office said.

As legislators push their outside consultant proposals, the ARHealth, ARJobs coalition will make its official debut later this week and identify its members, Hanley said.

The group will offer “constructive dialog,” he said.

States have the option of participating in a federally backed expansion that would be fully funded by the government until 2017. By 2020, the state would pay for 10 percent of the cost.

“The groups coming together ... have missions to promote, improve, and expand health care in Arkansas - why would these groups not get involved.” Hanley said in an e-mail regarding the pro-expansion coalition. “Collectively our voices are louder and stronger, so we have all decided to join together.

“This is a vital issue for our state, and Arkansans need to know what is at stake.”

Burris said he didn’t think the coalition would sway many lawmakers.

“We all know the facts. We’re just gathering the data. It’s not a surprise that people who would benefit most from expansion are going to organize and tell us why it looks good for their bottom line. But we have to look at the big picture,” Burris said.

Several key lawmakers said that despite the lack of legislation on Medicaid so far this session, it still looms large as a huge policy decision.

“There’s a lot happening. It’s just natural that the biggest decisions get made after we’ve spend the most time looking at them. And I think that’s what is happening with Medicaid,” Burris said.

In the fall, Human Services Department officials warned that nursing care for the frail elderly would be eliminated and other programs cut or frozen to plug a $138 million deficit. A slower than expected growth in the program since July prompted the department to recalculate the projected deficit to $61 million at the end of January, attributing the smaller gap to providers trimming fat in anticipation of the state’s Medicaid payment overhaul, which began in October.

“I think the revised Medicaid numbers have taken some of the immediacy out of the discussion,” DeCample said.

But the governor always expected the issue to be settled late in the session after members had time to digest the competing arguments, he said.

Carter said Medicaid is receiving ample attention - behind closed doors for now.

“Don’t think because there are not any bills filed that we’re not all working on it. It’s just sort of behind-the-scenes stuff,” he said.

Front Section, Pages 1 on 02/19/2013

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