In a divided voice vote, the Legislative Council on Friday approved rules limiting in-home Medicaid assistance to the elderly and disabled and cutting payments to assisted-living facilities.
The changes, which take effect Jan. 1, are part of the state's efforts to slow the growth of spending in the traditional Medicaid program that covers the elderly, disabled and children from low-income families by enough to pay the cost of extending eligibility to adults with incomes of up to 138 percent of the poverty level.
Although state officials had reached an agreement with assisted-living facilities on the rate reduction, providers of in-home care remained opposed to the changes to the ARChoices program, which they contend will result in more people ending up in nursing homes.
Some critics also complained about the involvement of the Arkansas Health Care Association, which represents nursing homes, in crafting rules the opponents say will benefit the association's members.
"People are very much concerned about this, especially the elderly and those individuals who are in assisted living" or receiving services at home, Sen. Linda Chesterfield, D-Little Rock, told state Department of Human Services officials at the meeting.
"What do I tell them if I vote for this that I have not done something to harm them?"
Mark White, deputy director of the department's Aging, Adult and Behavioral Health Services Division, said some ARChoices recipients will have their benefits reduced, but he's "not expecting it to be a large number of people."
He noted that, in addition to the services that will be subject to cost caps, ARChoices recipients will still be able to receive regular Medicaid benefits, including 64 hours a month of in-home care under the program's personal care benefit.
"When you take all those services into account, I think we can take care of our beneficiaries," he said.
ARChoices provides help with daily living tasks and other needs for about 8,800 low-income people with disabilities severe enough to qualify for placement in a nursing home.
The caps will be set at $30,000 a year for recipients with the greatest needs -- those who require total or extensive assistance with moving about, eating and using the bathroom.
Recipients requiring assistance with only two of those activities will be eligible for up to $20,000 of care. The annual cost for those with less extensive needs will be capped at $5,000 each.
Recipients who are currently receiving more than $30,000 will be allowed to continue receiving their current level of care in 2019 and 95 percent of that amount in 2020.
Recipients will also be able to request a temporary increase in their cap to address "exceptional circumstances," such as the death of a spouse or caregiver or an increase in needs after a hospitalization.
The state will also scrap an algorithm it uses to assign recipients to "resource utilization groups" based on their medical diagnoses and answers to questions about their needs.
Instead, the hours will be calculated based on an estimate of how many minutes of assistance the recipient needs with tasks such as dressing, eating and bathing.
The current system for allocating benefits has been the subject of lawsuits by Jonesboro-based Legal Aid of Arkansas, which argues that the formula caused widespread reductions in the hours of in-home assistance.
White said the new system will allow more flexibility than the current one in addressing the needs of each recipient.
Rep. Jim Dotson, R-Bentonville and a council chairman, declared the rules approved after the vote.
His fellow chairman, Sen. Bill Sample, R-Hot Springs, attempted to block the proposal at a meeting of the council's Administrative Rules and Regulations Subcommittee on Thursday but didn't speak against it at the full council meeting Friday.
After the meeting, Sample said he tries as chairman to remain neutral on matters being considered by the council. Also, he said, "We just didn't have the votes."
"I can count pretty good, and I know what it takes" to reject a regulation, he said.
Metro on 12/22/2018