A measure appropriating more than $9 billion in state and federal funds for use on Medicaid and other Department of Human Services programs failed to pass an initial vote Tuesday in the House.
The Division of Medical Services appropriation has faced a perennial challenge from conservative lawmakers since the adoption of the private-option Medicaid expansion program in 2013. Despite initial difficulties, the Legislature has always managed to approve the funding to continue the program.
The appropriation requires a three-fourths majority in each chamber to pass. Senate Bill 55, this year's medical services appropriation, fell short with a 54-31 vote in the House on Tuesday. Seventy-five votes were required for passage.
"It rarely passes on the first vote," said Rep. Lane Jean, R-Magnolia, the co-chairman of the Joint Budget Committee.
The Senate passed SB55 on its first try in late March, voting 28-5 to send the bill to the House. Twenty-seven votes were required for passage.
The appropriation includes funding for both the traditional Medicaid and the Medicaid expansion, which together provide health care services to more than 1 million low-income Arkansans, according to the Human Services Department.
The Medicaid expansion program was overhauled by lawmakers earlier this session to allow the Human Services Department to seek a new waiver from the federal government to promote work through access to government-subsidized private insurance plans. Enrollees who fail to meet the incentives will be moved to traditional Medicaid under the new plan, called Arkansas Health and Opportunity for Me (ARHOME).
Opponents of the Medicaid expansion attempted to scrap the plan and move all of the enrollees to traditional Medicaid's fee-for-service plan, but that attempt failed.
On Tuesday, Rep. John Payton, R-Wilburn, made a procedural motion to separate the appropriation for the expansion program the bill so that it could be voted on separately. That motion was defeated on a voice vote.
The medical services appropriation for fiscal 2022, which begins July 1, includes $6.6 billion in federal funds and $2.08 billion in state matching funds, according to Human Services Department spokeswoman Amy Webb.
Of that, $1.96 billion in federal funds and $218 million in state funds were allocated to the expansion program.