Medicaid expansion advances with bill

The Legislature’s Joint Budget Committee on Monday approved the state Department of Human Services’ Division of Medical Services appropriation — which includes spending authority for the state’s version of Medicaid expansion — for the coming fiscal year.

In a voice vote with a few dissenting lawmakers, the committee sent Senate Bill 30 to the Senate for further action.

But Senate Republican leader Jim Hendren of Sulphur Springs said Monday afternoon that he didn’t have the required 27 votes lined up to approve SB30. The Senate has 32 members and three vacancies because of resignations of two senators and the death of a third.

The Senate could vote on the bill today or Wednesday, he said.

“I feel better today because I think the administrator’s visit was very helpful,” Hendren said, referring to the federal Center for Medicare and Medicaid Services administrator, Seema Verma, who went to the state Capitol. Verma signed a waiver allowing the state to implement a work requirement for some enrollees in the Medicaid expansion, which is called Arkansas Works. Arkansas Works insures about 280,000 enrollees.

“I still have not gotten a hard count [on Senate votes]. It’s almost game day and we still don’t have the count, but sometimes we just roll it out and see what happens,” Hendren said.

SB30 would grant $8.2 billion in spending authority to the Medical Services Division in fiscal 2019, which starts July 1. Arkansas Works is projected to cost about $135.6 million in state funds and about $1.9 billion in federal funds. The state’s share of the cost of the program is 6 percent this year and will eventually reach 10 percent in 2020 under existing federal law. Each year, the division’s appropriation has had difficulty getting approval from the Republican-majority Legislature.

Several senators told a reporter they’ve not decided how they’ll vote for SB30.

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Sen. Linda Chesterfield, D-Little Rock, said she voted against the bill in the committee partly because she is concerned about the work requirement. In some parts of the state, there is no work or school for people to comply with the requirement, she said.

“Right now, I am just pondering,” she said.

Sen. Scott Flippo, R-Mountain Home, said he will seek more information before he decides how he will vote, though he “appreciated the administrator coming to take the time to come and visit with us today.”

“It has been a difficult process historically since Day 1 with this. I think some of us have the same concerns and others have their own concerns, so we’ll find out soon enough,” he said.

Sen. Gary Stubblefield, R-Branch, said, “I told the governor I might have went from a ‘hard no’ to a ‘soft no.’ I still have some other questions, but it was an interesting discussion. [Verma] brought up some good points, so we’ll see.” He said he has questions about the cost of setting up the work requirement.

Sen. Alan Clark, R-Lonsdale, said he has gone from a “hard no” to a “friendly no.”

“I am very complimentary of the governor and his administration for asking for the work requirement and DHS and DWS for the way they’ve handled it,” he said, referring to the Department of Human Services and the Department of Workforce Services.

“I think they’ve really put a lot into it and to the Trump administration for doing it. That makes it much more palatable to me than it has ever been, but that doesn’t necessarily make it a yes,” Clark said.

Sen. Linda Collins-Smith, R-Pocahontas, said she will probably vote against the bill.

Meanwhile, several representatives said they don’t think it will be a problem to get 75 votes for SB30 in the House, which has 99 representatives and one vacancy due to a resignation.

“I think it’s pretty much a done deal,” said Rep. Stephen Meeks, R-Greenbrier. “I’m not sure about the Senate side. The work requirement will certainly help.”

Meeks said he’ll still probably vote “no” on the appropriation, but said the work requirement makes it easier to swallow.

Rep. Brandt Smith, R-Jonesboro, said he expects to vote for the bill now that the federal government has approved the work requirement waiver.

He called that an “about-face” for himself. He said he still wants to learn more about the impact of a federal lawsuit joined by Attorney General Leslie Rutledge that’s challenging the Affordable Care Act.

Rep. James Sturch, R-Batesville, said he’s leaning “yes” on the bill after Monday’s work-requirement announcement. However, he said he still wants to learn a bit more.

Rep. Michelle Gray, R-Melbourne, said she plans to vote for the appropriation. Earlier in the session, Gray said she’d vote against the measure unless a remedy to the pharmacy benefit managers issue was brought forward. She said Monday that she’s been assured the matter will be addressed in a special session immediately after the current fiscal session adjourns. She’s also comfortable with the appropriation because of the work requirement.

“The work requirement is really big,” she said. “I’ve heard a lot from my district about the work requirement.”

House Speaker Jeremy Gillam, R-Judsonia, said, “My suspicion is this helps alleviate some of concerns,” adding that he hasn’t seen a count.

“Just based on the conversations that I’ve either been a part of or [have] been relayed to me, there doesn’t seem to be widespread opposition to the program right now,” Gil-lam said.

Information for this article was contributed by Hunter Field and John Moritz of the Arkansas Democrat-Gazette.