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Governor spells out Medicaid proposal

State plan gains think-tank praise by Frank E. Lockwood, Michael R. Wickline | July 24, 2021 at 4:32 a.m.
FILE — In this Jan. 13, 2020 file photo, Arkansas Gov. Asa Hutchinson speaks to reporters in Little Rock. (AP Photo/Andrew Demillo, File)

WASHINGTON -- Arkansas Gov. Asa Hutchinson outlined his vision Friday for overhauling the state's expanded Medicaid program, telling an American Enterprise Institute audience about the proposed Arkansas Health and Opportunity for Me program.

The project, which has been branded ARHOME, received praise during a panel discussion that followed the governor's speech, though its predecessor, Arkansas Works, was referred to as a "disaster" by the panel's moderator.

Unlike the previous Medicaid waiver, ARHOME does not condition coverage for some recipients on work, job training or volunteer service.

The work provision, approved by the Trump administration, was ultimately struck down in federal court.

The Hutchinson administration this week applied for a new waiver from the U.S. Centers for Medicare and Medicaid Services.

Arkansas and U.S. Department of Health and Human Services officials met this week and discussed the new request.

The changes are necessary in order to address the state's substantial health care needs, Hutchinson told the conservative-leaning think tank's gathering.

"The health care plan that we seek to build in Arkansas is both conservative and compassionate. It is both conservative and practical. It is both conservative and based upon common sense," Hutchinson said. "It is my hope that the Biden administration will approve this innovative approach to health care, and that conservatives will see it as a practical means to take an expansive federal program and overlay it with the efficiency of the private sector."

In Arkansas, the Medicaid expansion program provides private health insurance for adults between 19 and 64 years old who earn up to 138% of the federal poverty level, which is $17,774 for a single person and $36,570 for a family of four.

Its enrollment totaled 321,053 on June 1, according to the latest figures on the state Department of Human Services' website. On March 1, 2020, before the coronavirus pandemic arrived in Arkansas, the program's enrollment totaled 250,233.

After Arkansas approved Medicaid expansion in 2013, the uninsured rate plummeted from 22.5% to 10.2% in 2016, Hutchinson said.

Despite the increased coverage, Arkansas ranked 48th in health outcomes, according to the America's Health Ranking Annual Report, Hutchinson said.

"Coverage itself is not enough to achieve the improvements in health care status that the people of Arkansas expect," he said.

"We want a new approach. We want more for the money. We are asking our health plans to do more; our hospitals to do more; and our enrollees to do more," he said. "In addition to providing health care insurance, ARHOME will focus on maternal health, mental health and addiction services, and improved delivery of health care in a very rural state.

"Let me emphasize that this is not just another Medicaid waiver that seeks to add coverage or deliver health care in a slightly different way. It goes directly to the linkage between poverty and poor health outcomes and, in many instances, regretfully, premature death," he said.

Outreach efforts will be crucial in order to improve health care outcomes, Hutchinson said.

"We cannot just wait for them to come through the door of the hospital or doctor's offices -- we must go out to them and meet them where they are," he said.

During a subsequent panel discussion, moderator Joseph Antos highlighted Arkansas' latest waiver request while also panning the state's previous Medicaid waiver program -- Arkansas Works.

"One of the things that didn't come up in our discussion with the governor was just what a disaster the work requirement provision was that Arkansas actually did implement for a while," said Antos, the American Enterprise Institute's Wilson H. Taylor Scholar in Health Care and Retirement Policy.

Federal judges blocked the pilot program after critics said it undercut Medicaid's statutory aim -- to help low-income Americans gain access to health care.

In addition to the policy dispute, there was a "mechanical issue" that was "pretty disturbing," Antos said.

The system for reporting failed to function well, he said.

"The population that had to satisfy the work requirement or lose their coverage had a great deal of difficulty telling the state that they were ... fulfilling the requirements," he said.

"This [was] a whole new idea. They'd never had to deal with this sort of thing, and they really weren't equipped to do it, even if they could have internet access," he said.

Stuart Butler, a senior fellow in economic studies at the Brookings Institution, portrayed the latest proposal as an improvement.

"It's a very exciting waiver. I mean, it really is. It could be extremely important," he said.

Kevin De Liban, director of advocacy at Legal Aid of Arkansas, was successful in a challenge to Arkansas Works in court.

In an interview Friday, he said ARHOME is also problematic.

"The new proposal still has lots of barriers and ways to keep people from getting the health care that they need," he said.

"They're putting co-pays on more people -- pretty much anybody on the program -- which wasn't the case before and then they're increasing premiums for people who are in a little higher income levels and they're also cutting retroactive eligibility," he said. "Right now if I go apply for Medicaid today, I can get coverage for medical bills for more or less the last three months. They're trying to cut that to one month."

Indiana University economics professor Kosali Simon said it's hard to judge the Arkansas proposal because a lot remains unknown.

It's "more of a framework," she said. "The devil is really in the details."

The new proposal will be worth following, Antos said.

"I assume that we'll be talking about this for weeks and months to come," he said.

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