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story.lead_photo.caption Ricky Taylor, an Arkansas secretary of state employee, sorts parking-assignment signs Tuesday at the state Capitol in preparation for today’s start of the special session. - Photo by Stephen B. Thornton

A special legislative session that starts today will consider Gov. Asa Hutchinson's proposal that would continue the state's expanded Medicaid program that provides health coverage to about 267,000 low-income Arkansans, while making changes the governor says would encourage recipients to stay employed and take responsibility for their health care.

Photo by Stephen B. Thornton
Herb Sanderson (center), director of the Arkansas chapter of AARP, shows a stack of 6,500 postcards from AARP members expressing support for Gov. Asa Hutchinson’s Arkansas Works health plan during news conference Tuesday at the Capitol with Hutchinson (left) and House Minority Leader Michael John Gray.

The formal call for the session that Hutchinson issued Tuesday did not include his proposal to hire private companies to manage and provide benefits to some Medicaid recipients as a way to save state tax dollars.

Hutchinson said Tuesday that he agreed to leave that proposal off the session agenda at the request of House Speaker Jeremy Gillam of Judsonia and Senate President Pro Tempore Jonathan Dismang of Searcy. The two Republicans told the governor in a letter Monday that lawmakers needed more time to consider the proposal.

The managed-care proposal is "the most comprehensive reform piece of legislation in terms of Medicaid that we've seen in decades and decades," Hutchinson said at a Tuesday news conference.

"There's a lot of money at stake, there's people interested in this, and it's complicated, and the Legislature wants more time to absorb it," he said.

The special session proclamation directs the Legislature to convene at 10 a.m. today to consider three issues: creating Arkansas Works while continuing the expanded Medicaid program, approving gubernatorial appointees and paying for expenses associated with the session.

First approved by the Legislature in 2013, the expansion of the state's Medicaid program extended coverage to adults with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four.

Most of those covered under the expanded part of the program receive the coverage through the private option, which uses Medicaid funds to buy coverage through private insurance plans.

The changes Hutchinson has proposed include charging premiums of about $19 a month to enrollees whose incomes are above the poverty level, subsidizing some enrollees' coverage through employer plans and referring unemployed enrollees to job-training programs.

As a way of paying for the state's share of the program's cost, Hutchinson has proposed hiring private companies to manage the health benefits for the developmentally disabled and mentally ill.

Hiring managed-care firms is part of a plan to curb the growth of state and federal spending for the traditional Medicaid program by $1.4 billion over five years.

That plan has drawn opposition from some lawmakers who fear managed-care companies would cut payments to health care providers and benefits to Medicaid recipients.

On Tuesday, the managed-care opponents released draft legislation of their own plan, called DiamondCare , that a consultant has estimated would save about $1 billion over five years without managed care.

Lawmakers listed as the bill's sponsors said they hadn't yet decided whether to try to introduce the legislation during the special session.

"I think we have to wait to see how everyone feels about the bill when they read it," Rep. Deborah Ferguson, D-West Memphis, said.

The draft DiamondCare legislation lists Rep. Michelle Gray of Melbourne and Sen. Missy Irvin of Mountain View, both Republicans, as lead sponsors.

Ferguson is also listed as a sponsor along with Republican Reps. Joe Farrer of Austin and Justin Boyd of Fort Smith and Sen. John Cooper of Jonesboro, along with Democratic Sens. Keith Ingram of West Memphis and Linda Chesterfield of Little Rock.

Five of the eight sponsors have a financial connection to the health care industry: Gray and Irvin are married to family physicians and work at their husband's clinics.

Ferguson is a retired dentist whose husband, Scott, is a radiologist. Farrer is a physical therapist and former administrator at North Metro Medical Center in Jacksonville. Boyd is a pharmacist.

"Together, we have a combined expertise in health care," Irvin said at a news conference on the legislation. "That's undeniable."

She said their contributions are "part of the dialogue, and that's what should occur in a citizen Legislature."

All of the sponsors except Irvin are members of the Health Reform Legislative Task Force, which was formed more than a year ago at Hutchinson's request to study changes to the state's Medicaid program. The Arkansas Works legislation and the managed-care proposals grew out of the task force's work.

Hutchinson's proposal calls for the state to pay managed-care companies a fixed per-recipient amount to provide health benefits to the mentally ill and developmentally disabled.

The DiamondCare plan calls for the state to hire companies to help reduce the cost of caring for the same populations, but for the state to continue paying health care providers directly.

Under both plans, the state would hire managed-care companies to provide dental benefits and continue to serve nursing home residents, elderly people with disabilities and children from low-income families under the fee-for-service Medicaid program.

Both plans also call for the state to adopt measures proposed by the Arkansas Health Care Association, which represents the nursing home industry, that the group says would save $250 million over five years in spending on long-term care for the elderly.

Hutchinson has proposed directing at least $25 million annually toward reducing the number of people with developmental disabilities who are on a waiting list for home-based services, such as help with daily living tasks. About 2,600 people are on the list.

The DiamondCare plan would direct $15 million annually, including an estimated $4 million in insurance premium taxes that would be collected on the dental managed-care plans, toward serving people on the list.

The legislation calls on the state to establish tiers of care for recipients with such disabilities and cap benefits for those with less extensive needs. With the spending more accurately targeted, Gray said the $15 million, which would be matched with $35 million in federal funds, would be enough to serve everyone on the list.

Hutchinson said the DiamondCare proposal would save less money and hasn't been tested elsewhere in the country.

"That's a risk that I don't want to take," Hutchinson said.

At a health reform task force meeting later Tuesday, Stephen Palmer, a senior consultant with The Stephen Group of Manchester, N.H., said other states have successfully implemented managed fee-for-service models, such as the one that would be employed by DiamondCare, but said the trend has been toward managed care.

Hutchinson didn't say when he will ask the Legislature to consider the managed-care issue again. He said he was hopeful that the regular fiscal session, set to begin in a week, will give legislators time to come to a consensus.

Meanwhile, House Minority Leader Michael John Gray of Augusta said Democrats have been working with Hutchinson on changes they want to see in the Arkansas Works legislation.

For instance, he said he wants to make sure enrollees who enroll in employer-sponsored plans that would subsidized by Medicaid won't face a gap in coverage if they lose their jobs.

"The governor has been real reasonable in the conversations," Gray said. "We want to just make sure that we come out of here with good policy."

Information for this article was contributed by Michael R. Wickline of the Arkansas Democrat-Gazette.

A Section on 04/06/2016

Print Headline: Medicaid plan up today, less managed care

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