State approves Medicaid for Marshallese residents

Federal law cited in emergency rule change

FILE — The state Capitol is shown in this 2019 file photo.

The Legislative Council's Executive Subcommittee this week signed off on an emergency rule for the state Department of Human Services to make adults in the Marshallese population eligible for Medicaid coverage.

The emergency rule will become effective Tuesday .

The Medicaid coverage would be for adults who are in the Compact of Free Association islands and are allowed through treaties to live and work in the United States "because of the nuclear testing that was done on their islands back in the '50s and '60s," said Mark White, chief of legislative affairs for the state Department of Human Services.

In December, then-President Donald Trump signed a law approved by Congress that extends coverage for all adults who meet the income and other requirements for Medicaid coverage, White told the subcommittee on Tuesday.

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They were made ineligible for federally-supported Medicaid coverage by the welfare overhaul law signed by then-President Bill Clinton in 1996. Another federal law, passed in 2009, gave the states the option to extend Medicaid coverage to Marshallese children. In 2017, the state extended coverage to Marshallese children.

The state Department of Human Services is proposing an emergency rule partly because a normal rule would not take effect until July and "that gives a bit of time that we would be out of compliance with the new federal law," White said.

In addition, covid-19 "has had a real strong impact on this community in particular and we know there is a lot of need there, so we want to try and get some care for those folks who are dealing with covid," he said.

The department projects the rule would cost $1.8 million in state general revenue in fiscal 2021, which ends June 30, and $3.7 million a year in subsequent fiscal years, White said.

The department projects the rule will cost $4.6 million in federal funds in fiscal 2021 and $9.3 million in federal funds in subsequent fiscal years.

The projections are based on providing Medicaid coverage to about 1,678 adults, department spokeswoman Amy Webb said Wednesday.

But White told the executive subcommittee on Tuesday, "I just want to caution you that [the projected cost estimate] is a very worst case scenario."

He said it's a worst-case scenario because "it is based on the number of individuals who signed up," and "we look at the data and take our best guess at the high number."

He said the cost estimate also assumes all of these adults are eligible for the state's traditional Medicaid program, which requires the state to provide matching funds of 30%.

"Realistically, we expect most of these individuals would come under Arkansas Works, which is a 10% state match," White said.

"I think we can expect the actual amount to be a fraction of this [estimate], but we want to be very conservative," he said.