Arkansas officials are confident that they can secure federal approval for a proposal that would limit when people can sign up for coverage under the state’s private-option Medicaid program, a spokesman for the state Department of Human Services said Friday.
Meanwhile, another proposal aimed at winning legislative support for the program has already prompted the Department of Insurance to scale back its request for federal grant money to help people enroll in plans on the state’s health insurance exchange during the state’s fiscal year that starts July 1.
The Insurance Department had planned to request more than $8.5 million from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services to advertise available options and pay outreach workers to help Arkansans sign up, said Deputy Insurance Commissioner Cynthia Crone.
Instead, the application submitted to the federal agency Feb. 14 requested less than $1.5 million, which would support Insurance Department staff members, call-center personnel and the regulation of plans on the exchange.
“We’ll just go forward, and we’ll do the best that we can do to make this work,” Crone said last week.
The restricted enrollment period and ban on outreach are part of a potential compromise under discussion by state lawmakers that would allow funding to continue for the state’s expanded Medicaid program.
The state Senate narrowly approved continued funding for the private option last month, but the House has failed four times to reach the necessary supermajority to continue funding the healthcare program.
Authorized by the 2010 federal Patient Protection and Affordable Care Act and approved by the state Legislature last year, the expansion extended eligibility for Medicaid coverage to adults with incomes of up to 138 percent of the poverty level - $16,105 for an individual or $32,913 for a family of four.
Under the private option, most of those who are eligible can sign up for plans on the state’s private insurance exchange and have the premiums paid by Medicaid dollars. Those who are considered to have exceptional health needs are assigned to the traditional Medicaid program.
For coverage for the newly eligible adults to continue past June 30, the Legislature must approve the appropriations bill for the Human Services Department’s Division of Medical Services, which includes $915 million in federal funding that would pay for the coverage.
The legislation requires the support of a three-fourths majority in the Senate and House - 27 of 35 Senate members and 75 of 100 House members.
Language attached to appropriations bills would prohibit the state Human Services, Insurance and Health departments from promoting enrollment in the state’s Medicaid program or insurance exchange.
The state Senate approved the Medical Services Division appropriation, including the ban on outreach by the Human Services Department, 27-8, on Feb. 20, but the legislation failed four times in the House to win the necessary votes for passage.
That prompted lawmakers last week to begin discussing an additional compromise that would seek to limit enrollment in the private, Medicaid-funded plans to certain periods, much as sign-ups for other plans are limited under the federal health-care law.
Outside of the enrollment periods, people would still be able to sign up for Medicaid, but they would be covered under the traditional, fee-for-service program.
Human Services Department spokesman Kate Luck said Medicaid recipients who did not have exceptional health needs would then have to choose private plans during the next enrollment period, or they would be automatically assigned to one.
Human Services Department officials have discussed the proposal with their counterparts at the Centers for Medicare and Medicaid Services and “feel confident that CMS will accept these provisions,” Luck said.
The enrollment periods “may dampen enrollment a little bit, but at the end of the day, there’s still health coverage options available for this population. So we don’t see it slowing down too much,” she said.
Gov. Mike Beebe is “definitely open to the idea,” spokesman Matt DeCample said.
“It’s not going to deny coverage to anyone who’s eligible,” DeCample said. “If you don’t apply within that window, you would go to expanded Medicaid, and then you would have the potential to move over to the private option.”
Rep. Kim Hammer, R-Benton, who has voted against expanding Medicaid, said Friday that designating an enrollment period would introduce “a level of personal accountability” to the program, help insurance companies in setting their rates and make the plans more similar to private, employer-sponsored insurance.
Rep. Charlie Collins, R-Fayetteville and an expansion supporter, said the proposal would not be part of the Medical Services Division appropriation bill. Instead, state officials would agree in writing to ask the Centers for Medicare and Medicaid Services for permission to establish the enrollment periods.
The ban on outreach by the Insurance, Human Services and Health departments would not prevent those agencies from providing Arkansans with “factual information” about the enrollment periods, Collins said.
“Enrollment dates, I would imagine, would be considered facts as opposed to promotions,” Collins said. “Could you do television advertising? No.”
Although the federal government is paying the full cost of covering the newly eligible adults, opponents have said they don’t want to increase federal spending and doubt that the state will be able to afford its share of the program after it starts paying a portion of the cost in 2017.
The state share will start at 5 percent, then increase each year until it reaches 10 percent in 2020.
Proponents of the expansion say the costs will be offset by savings in uncompensated care and the elimination of more limited programs for the same population that required a higher dollar match by the state.
Because of the state’s 2.5 percent tax on insurance premiums, the private-option plans also generate tax revenue. An amendment to the Insurance Department’s appropriation bill would require premium tax money generated by the private option next year to be placed in a trust fund to pay for future costs of the program.
Enrollment in the state’s expanded Medicaid program and plans on the insurance exchange began in October for coverage that started Jan. 1.
As of early last week, 105,561 newly eligible adults had signed up for Medicaid. That included 93,966 people who are in private, Medicaid-funded plans, and 11,595 who were assigned to the traditional program because of their health needs. More than 20,000 other applicants had been found eligible but had not completed enrollment.
An estimated 250,000 Arkansans are eligible for coverage under the program.
“We seem to be approaching that target enrollment quicker than almost anyone had predicted,” state Medicaid Director Andy Allison said last week.
By contrast, the Insurance Department reported last week that 26,201 Arkansans who did not qualify for Medicaid had enrolled in plans on the state’s insurance exchange as of Monday.
That was an increase of 20 percent from the 21,763 Arkansans who the U.S. Health and Human Services Department reported had signed up as of Feb. 1, but well below the 116,000 people an Insurance Department consultant predicted would sign up by March 31, the end of this year’s enrollment period for those who do not qualify for Medicaid.
“It is way under our eligible target and where we had hoped we would be at this point,” Crone said.
Sign-ups in October and November were hampered by problems with the federal enrollment portal, healthcare.gov .
Crone also cited the state Legislative Council’s refusal in October to review an Insurance Department contract with an advertising firm that would have provided $4.5 million for a campaign encouraging people to sign up.
With the contract in limbo, the department has been relying on about 500 outreach workers, hired through contracts with state agencies, nonprofits and private businesses, to spread the word and help people enroll.
“What we need is air and ground cover, and what we’ve had is the ground,” Crone said.
Before the outreach ban was attached to the department’s appropriation bill, she said, the department had planned to keep about 250 of the outreach workers to help during the next enrollment period, which starts Nov. 15.
Rep. Nate Bell, R-Mena, who sponsored the amendments banning outreach after June 30, has said his goal was to slow enrollment in the private option while winning the support of enough conservative Republicans to avoid a stalemate over the Medicaid appropriations bill.
While the bans would apply only to the Insurance, Human Services and Health departments, Collins said it’s his understanding that no state agency or department will be conducting outreach.
“There’s basically the commitment that people are not going to be looking for an end run on this,” Collins said.
DeCample said “there were no side agreements” barring other agencies from conducting outreach. But he added that other agencies have not been using “their own state resources” to promote enrollment, and “the governor does not anticipate that happening” after June 30.
Front Section, Pages 1 on 03/03/2014