LITTLE ROCK — A letter sent to the federal government Wednesday by the Arkansas Department of Human Services outlines in concrete and exhaustive detail the oral agreement reached last month by Gov. Mike Beebe and U.S. Secretary for Health and Human Services Kathleen Sebelius in an attempt to nail down the unprecedented deal they reached regarding Medicaid expansion.
Slightly more than two pages long, the missive from the Department of Human Services to the federal Center for Medicare and Medicaid Services describes the state’s plan to expand Medicaid to approximately 250,000 Arkansans as an effective way to increase competition, lower health-care costs and increase “ownership” among Medicaid recipients in their own health.
The letter’s goal: make sure the federal government and the state are on the same page regarding the plan to cover poor Arkansans earning up to $15,415 a year by giving them private insurance on the state’s health-insurance exchange. Medicaid would pay their premiums.
“We want their stamp of approval. An official thumbs up,” Human Services Department spokesman Amy Webb said of the letter.
Many lawmakers have been seeking a formal reply from the federal health agency that will seal Arkansas’ deal in stone.
The state’s letter to the Center for Medicare and Medicaid Services doesn’t explicitly ask for such a response, but Webb said its intent is plain.
The letter, obtained by the Arkansas Democrat-Gazette in a state Freedom of Information Act request, also aligns with Republican goals to reduce the existing Medicaid program, which serves about780,000 people.
“Arkansas is taking an integrated and market-based approach to covering low-income Arkansans, shrinking rather than expanding a Medicaid program that is separate and duplicative,” the document states.
Pregnant women and people who incur sudden and high medical bills would be shifted to the state’s health-insurance exchange. The ARHealth-Networks program would be eliminated, as would “potentially” other services such as the breast- and cervical-cancer program and the tuberculosis program, according to the letter.
The insurance exchange would benefit from being the vehicle used for Medicaid expansion because more people might create a more competitive insurance market in Arkansas, state officials argue.
“This would enhance the attractiveness to new carriers,” the letter states.
Meanwhile, Republicans continue to discuss - and argue - over how to craft a plan that can win over 75 House members and 27 senators, the three-quarters majorities needed for approval. Republicans control both chambers, and their support is necessary for any deal.
A Tuesday meeting of GOP leaders at the Copper Grill indowntown Little Rock occasionally broke into heated debate on how to put meat on the bone for legislation to expand the $5 billion Medicaid program, which covers poor, elderly and disabled Arkansans, according to several participants.
That’s to be expected, said Rep. Bruce Westerman, R- Hot Springs, who took newly hired Medicaid consultant and former Pennsylvania health-care guru Gary Alexander to the meeting.
“Have you ever been to a Capitol meeting where there wasn’t disagreement?” Westerman said in response to inquiries about the meeting.
Rep. John Burris, a Harrison Republican, said different groups of GOP leaders have different ideas on how to proceed.
“We’re in the policymaking business. To say there are factions is to say the sky is blue at noon,” Burris said.
Burris said he’s pleased that the Department of Human Services letter incorporates many of his party’s goals. Hementioned a desire to shift the approximately 75,000 children enrolled in ARKids B, which covers those whose family incomes equal up to 200 percent of the federal poverty line, to the insurance exchange, where their parents will qualify for heavily subsidized private coverage with low premiums.
“Family plans make more sense and would be cheaper,” Burris said.
The letter echoes that goal, saying that the state intends to use “available flexibility” to shift those children to the exchange with their parents.
Webb, the Human Services Department spokesman, said it was her understanding that such a move couldn’t be made under federal law for at least a few years.
State officials haven’t yet “developed” cost-sharing mechanisms, such as copays, but they would also be sought, according to the letter, incorporating another Republican objective.
The state social-services agency proposes having Medicaid-covered people pay between 2 percent and 5 percent for some services, roughly the same financial contribution already in place for the “lowest-income” people who qualify for the exchange but not for Medicaid-paid insurance, which would end at 138 percent of the federal poverty line.
Meanwhile, legislators continue to hash out the fine points, said Sen. Paul Bookout, D-Jonesboro, who filed a “shell” bill on expansion last week.
Bookout said Wednesday that a substantive bill likely will take time.
Making good law takes time, said Sen. David Sanders, a Little Rock Republican who was at the Copper Grill meeting.
“The reality is this, in Arkansas right now, we are at the early stages. But we’re working hard and fast at adding to a very loose policy framework that we’ve been given verbally. When you’re working through things, talking about all the aspects of passing legislation, people have differing opinions,” Sanders said.
Front Section, Pages 3 on 03/14/2013