For the second consecutive day, a measure on granting authority for the state's Division for Medical Services to use up to $9 billion in federal and state funds in the next fiscal year failed to clear the Arkansas House of Representatives on Wednesday.
The House's 66-24 vote on Senate Bill 55 fell nine votes short of the 75 required for approval in the 100-member chamber. Seven representatives didn't vote, and three others voted present.
On Tuesday, the House's 54-31 vote on the bill was 21 votes short. One member voted present, and 14 didn't vote.
Wednesday's vote came shortly after the House rejected a motion by Rep. Josh Miller, R-Heber Springs, to have a separate vote on the Medicaid expansion portion of the appropriation. Miller opposes the Medicaid expansion program, which provides private health care coverage for about 300,000 low-income adults. The House on Tuesday rejected the same motion by Rep. John Payton, R-Wilburn.
Miller told representatives that "for years, we've been promised that we can have a separate vote on this [Medicaid expansion appropriation], so people would feel like we can debate and hash out the merits of the Medicaid expansion program, any changes that may need to be made to that, and have that separate out from the entire DHS budget."
But Rep. Michelle Gray, R-Melbourne, countered that trying to pull the Medicaid expansion part out of the total Medicaid budget would be difficult because "there is a certain percentage of those people [in the Medicaid expansion program] that are actually going to transition back to traditional Medicaid" in the absence of the Medicaid expansion program.
"They don't all lose coverage, so then we would have to go back and adjust the rest of the [Department of Human Services] budget as well, so pulling it out is not as simple as, we can pull it out and vote on it separately," she said. "We would have to pull it out and vote on it separately and change the other DHS appropriation."
"I feel like we voted on the policy already," Gray said. "That has passed. It is over and done."
But Miller replied: "Nobody is going to lose coverage. None of this stuff happens today. What we are talking about is, let's just have a separate vote on this funding."
There are plenty of representatives who want to have this debate, he said.
"There also are other options out there that we can all still do and do it in a timely fashion and take ourselves home real soon," Miller said.
House Republican leader Austin McCollum of Bentonville voted against the appropriation both days.
While some Republicans share his desire to see the bill split to allow separate votes on the appropriations for traditional Medicaid and the Medicaid expansion, other Republicans want a tougher version of a work requirement that is unlikely to be approved by President Joe Biden's administration, he said.
McCollum said ongoing discussions between Joint Budget Committee members and rank-and-file representatives are likely to soften the opposition.
"Inevitably, Medicaid will get funded," McCollum said. "There are some members who, timing-wise, don't want to vote for it right now."
The Division of Medical Services' appropriation each session since 2013 typically has had difficulty obtaining the required three-fourths vote for legislative approval because it includes spending authority for the Medicaid expansion program.
On March 30, the House voted 64-34 to approve separate legislation that retools the Medicaid expansion program, which has been called Arkansas Works. Senate Bill 410 is dubbed the Arkansas Health and Opportunity for Me Act. It's now Act 530.
Under this plan, the state aims to scrap the work requirement established by Gov. Asa Hutchinson and lawmakers in 2017 and replace it with a new system that incentivizes work and education with access to government-subsidized private health plans. The plan would require a new federal waiver from Biden's administration.
Unlike the House, the Senate approved SB55, the appropriation bill, on its first attempt to do so.
The Division of Medical Services' budget request for fiscal 2022, which begins July 1, sought $8.6 billion in total funds, comprising $6.6 billion in federal funds and $2.08 billion in state matching funds, according to Department of Human Services spokeswoman Amy Webb.
"Back in October when the biennial budget request was built, ARWorks FY22 was projected at $2.18 billion total with [the federal] share of $1.96 billion and state share of $218 million," Webb said last month. "Traditional Medicaid was projected at $6.47 [billion] total with [the federal] share of $4.59 billion and state share of $1.88 billion."
Because of the public health emergency resulting from the coronavirus pandemic, the Medicaid program's finances have been assisted by the federal government increasing the match rate for traditional Medicaid by 6.2 percentage points, retroactive to Jan. 1, 2020, to 77.62%. Webb said the Biden administration has extended the public health emergency through Dec. 31 of this year.
Information for this article was contributed by John Moritz of the Arkansas Democrat-Gazette.