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State seeks to log Medicaid users' work

Draft of federal request spells out job requirement, $2.5M website to track it by Andy Davis | May 20, 2017 at 2:49 a.m.

To implement a proposed work requirement for enrollees in the state's expanded Medicaid program, the Department of Human Services plans to build a website to track compliance, at a cost of $2.5 million to $3 million, a department spokesman said Friday.

Enrollees who fail to meet the requirement for three months during a year, even if the months are not back to back, would lose their coverage for the rest of the year.

Details on the work requirement are spelled out in a draft of the state's request for federal approval to make changes to Arkansas Works, as the expanded part of the state's Medicaid program is known.

The changes, which would take effect Jan. 1, also include moving about 60,000 Arkansans off the program by limiting eligibility to adults with incomes of up to 100 percent of the poverty level, instead of the current 138 percent of the poverty level.

To meet the work requirement, enrollees would have to spend at least 80 hours a month on approved activities, including holding a job; taking high school, college or vocational classes; training; volunteering; or "participating in activities or programs available through the Arkansas Department of Workforce Services."

Enrollees could also receive credit for spending up to 40 hours a month looking for a job and up to 20 hours a year taking classes on health insurance, using the health system or healthy living.

In an email, Human Services Department spokesman Brandi Hinkle said the enrollees will report their activities using the website, which will use "intelligent evidence gathering" to attempt to verify compliance.

"For example, if an individual puts in the form they have 10 volunteer hours, [the site] will then require the name of the organization, address, etc. to count those hours toward eligibility," Hinkle said in the email.

"An individual is unlikely to adequately falsify information that would be accepted by the software and therefore erroneously meet the requirements."

The federal government is expected to pay 90 percent of the cost to build the site, which will be built by Princeton, N.J.-based eSystems under an existing contract, she said.

The work requirement mirrors a condition already in place for food stamp recipients. But the Arkansas Works requirement would not apply to several categories of enrollees, including those who are 50 years old or older, live in a home with dependent children, or are full-time high school or college students, according to the draft waiver application.

The exemptions would likely cover more than half of the 270,000 enrollees who would remain on the scaled-back program, Human Services Department officials have said.

"With this amendment, the state will test innovative approaches to promoting personal responsibility and work, encouraging movement up the economic ladder, and facilitating transitions between and among" Arkansas Works' employer-sponsored coverage and coverage in non-Medicaid plans on the state's health insurance exchange, Human Services Department officials wrote in the draft request.

Gov. Asa Hutchinson proposed the changes to Arkansas Works as a way to reduce the cost of the program and encourage unemployed enrollees to find jobs.

Unlike President Barack Obama's administration, President Donald Trump's administration has indicated it will allow such changes, Hutchinson has said.

Marquita Little, health policy director for Arkansas Advocates for Children and Families, said the Human Services Department should enlist community organizations to spread the word about the changes and help enrollees who will be removed from the program find other coverage.

Most enrollees with incomes above the poverty level will be eligible for federally subsidized coverage offered through the state's health insurance exchange under the 2010 Patient Protection and Affordable Care Act.

Enrollees will likely need help understanding their options and complying with the work requirement, Little said.

"One of the major issues we consistently have with the program are the poor investments in outreach and education," Little said.

She cited the state's ARKids First Medicaid program, which terminated coverage for about 57,000 children in March after their parents failed to visit a state website to provide information needed for an eligibility check.

The Human Services Department is limited in the outreach it can provide. Special language attached to the appropriation bill for the state's Medicaid program prohibits it from encouraging enrollment in Arkansas Works or the health insurance exchange.

Under the so-called private option, most Arkansas Works enrollees receive coverage through plans on the state's health insurance exchange, with the Medicaid program paying the premium and providing additional subsidies that reduce or eliminate enrollees' out-of-pocket charges for medical care.

Last year, the Obama administration granted Hutchinson approval to make an initial round of changes that the governor said would encourage enrollees to stay employed and take responsibility for their health care.

Those changes, which took effect Jan. 1, include charging premiums of $13 a month to enrollees with incomes above the poverty level, referring enrollees to job training programs and using Medicaid funds to subsidize job-based coverage for some small business employees.

The proposed waiver changes include eliminating the job-based coverage program, which has so far provided assistance to just one employee of one firm.

Starting July 1, the Human Services Department also wants to stop reimbursing new enrollees for up to three months of past medical expenses without meeting conditions imposed by the Obama administration.

The previous administration had required the state to amend its Medicaid plan to allow uninsured patients to receive temporary Medicaid coverage when a hospital makes a preliminary determination that they are likely to be eligible.

Hinkle said Friday that some hospitals are already making the preliminary determinations, even though the state hasn't issued a state plan amendment.

Under the proposed Arkansas Works waiver amendment, retroactive coverage for a new enrollee would be limited to the first day of the month when the Medicaid application was submitted.

Under the 2010 Patient Protection Affordable Care Act, the federal government paid the full cost of coverage for newly eligible adults through the end of last year in states that expanded Medicaid.

Starting in January, the states became responsible for 5 percent of the cost. The health care law calls for the states' share to rise each year until it reaches 10 percent in 2020.

The Human Services Department will accept comments on the draft waiver amendment request at two public hearings. The first will be at 5:30 p.m. Thursday in the Darragh Center Auditorium of the Main Library at 100 S. Rock St. in Little Rock.

The second will be at 5:30 p.m. on June 6 in Arkansas State University's Cooper Alumni Center at 2600 Alumni Blvd. in Jonesboro.

The department also will accept written comments through June 18.

Metro on 05/20/2017

Print Headline: State seeks to log Medicaid users' work

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