Several groups, including Arkansas' largest health insurer, have critiqued components of the state's plan to seek federal approval for a revised version of the private option and a waiver extension through 2021.
The state Department of Human Services received nine written comments prior to Friday's public comment deadline.
The commenters, including private residents and Arkansas Blue Cross and Blue Shield, attacked a provision that would eliminate retroactive coverage for enrollees to "better align" the program with commercial insurance coverage. Currently, Medicaid covers up to 90 days of medical expenses incurred before the date an enrollee applied.
In a letter to the Human Services Department, Michael Baird, CEO of Human Arc, an eligibility services company, said that removing the retroactive coverage provision would harm patients and providers alike by saddling patients with medical debt and making it difficult for providers to collect compensation for treatment.
"Human Arc believes the evidence shows that the bulk of the savings will come at the expense of the low income uninsured expansion group through the elimination (waiver) of retroactive Medicaid coverage," he wrote. "The estimated savings are really a shifting of costs to the low income uninsured and the medical providers that serve them."
The revised private option, which would be renamed Arkansas Works, would also charge premiums of up to $19 a month to enrollees with incomes above the federal poverty level, provide coverage to some enrollees through subsidized employer plans and offer an extra benefit -- like dental care -- to incentivize annual wellness exams and timely premium payments.
How the comments will affect the proposal, which the state will submit to the Centers for Medicare and Medicaid Services on June 30, remains to be seen, according to a department spokesman.
"We will review those comments and make a determination if anything should be changed," spokesman Amy Webb said Monday, adding that all comments will receive a response in the final application.
Gov. Asa Hutchinson, who proposed the changes with the Legislature's approval, has said Arkansas Works would encourage enrollees to stay employed and maintain regular, preventive health care.
Under the private option now, Arkansas buys health coverage for low-income Arkansans with Medicaid funds through the state's federal-run insurance exchange.
The program extends 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. As of April 30, more than 292,500 Arkansas were approved for coverage under the expanded Medicaid program.
The federal government has paid the full cost of Medicaid expansion -- about $1.6 billion -- since its outset. Next year, though, the state will be responsible for paying 5 percent. The state's share will rise each year until it's capped at 10 percent in 2020.
Other groups commenting on the department's proposal included the Community Health Centers of Arkansas Inc., Arkansas Advocates for Children and Families, Arkansas Hospital Association and Health Management Systems Inc.
Each group urged the Human Services Department to keep the system as simple as possible and the transitions between plans seamless. They advised against distributing multiple insurance cards to individuals, which some enrolled in the employer-sponsored plans would receive.
Mary Leath, CEO of Community Health Centers of Arkansas, also cautioned the department about the $19 monthly premiums.
"We applaud the recognition of healthy behaviors, though for clarification, such should be clearly defined," she wrote. "Placing an additional financial burden on this patient population, even though minor in the eyes of you and I that make well in excess of the federal poverty level, can impact access to medical care to our most vulnerable in need of medical care.
"And we feel strongly that dental care should be a standard medical care not an 'incentive,'" she said, adding that many health problems can be traced to poor dental care. "If you want to add an incentive, add teeth whitening, or membership to a fitness center."
The comments also warned the department against cutting off nonemergency transportation, citing research showing that lack of transportation reduces the use of health services among low-income people.
Metro on 06/21/2016