Arkansas Legislators Seek Details on Medicaid Deal

by Andrew DeMillo, The Associated Press  on Sunday, Mar. 3, 2013 2:05 pm  

The announcement last week that the Obama administration had given Arkansas permission to pursue the plan as an alternative to expanding Medicaid eligibility alters a debate that legislators had said would be the top issue of this legislative session. (Photo by Stephanie Dunn)

"Our intention overall in doing this is for this as much as possible simply be seamless, that when people go into the private market they look like any other client going into the exchange," Selig said.

The other major question is how the state would set up co-pays that Republicans have long sought as part of any expansion agreement. Selig said recent federal guidelines give Arkansas and other states much more flexibility on co-pays for those making more than 100 percent of the poverty level.

The co-pays would likely be targeted more toward areas that Medicaid thinks recipients should be using less, such as going to the emergency room for non-emergency services, he said.

"I think there's a general feeling that where it's reasonable it makes sense to have cost-sharing at various income levels, particularly for things you want to discourage," Selig said.

Legislators say they want to see in writing what U.S. Health and Human Services Secretary Kathleen Sebelius promised Gov. Mike Beebe and state officials about the new Medicaid approach. The U.S. Department of Health and Human Services hasn't publicly confirmed many of the details that Beebe and DHS have announced about the new approach on expanding health coverage in the state.

"Our goal in working with states has been to be as flexible as possible within the confines of the law," Erin Shields Britt, a spokeswoman for the federal department, said last week. "In her meeting with Governor Beebe, Secretary Sebelius expressed support for ideas from the state that would take advantage of this flexibility and said she was glad to see the state considering an innovative, state-based approach."

Senate Public Health Committee Chairwoman Cecile Bledsoe said she wants to know more.

"What I heard were things that I liked, but I need the details and I feel like we need to handle it possibly in a special session," said Bledsoe, R-Rogers. "This is a very complicated matter, and it's not just a question of do you like what you've heard but how does it all work together?"

Beebe has said he wants legislators to make a decision in the current session.

The other hurdle may be a lack of detail so far on how much the private plan would cost as opposed to regular Medicaid expansion. Selig has said the department expects costs for Medicaid will likely go down since it wouldn't have the administrative costs of adding more people to its rolls, but Beebe has said legislators likely won't see a new dollar figure before they vote on this plan.

Beebe has said a proposed "sunset provision" that would require legislators to re-approve the deal before Arkansas' costs kick in after three years would give the state a track record on the cost of the private plan.

The idea still must win over three-fourths of the House and Senate. Republicans are far from saying they're ready to back on to the proposal, but say they're at least ready to move closer to a potential vote.

"We now have the rules to the game," said Sen. Jonathan Dismang, R-Beebe. "So we get to tailor and see what we can come up with."

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