Medicaid Expansion In Arkansas Worth Serious Consideration

In June two state legislators wrote to me asking that I assist their constituent in navigating the Medicaid eligibility process. The woman they were trying to help had been in a bad accident, was unable to work for the foreseeable future, had no income and had astronomical medical bills.

Today, almost two months later, we still don’t know if she will qualify for assistance, because of all the medical documentation required to determine disability. And she and her medical providers don’t know who, if anyone will pay the bills.

It’s a common misperception that if you are low income you qualify for Medicaid. While that’s generally true for children thanks to ARKids, it’s far from true for adults. With few exceptions, for adults in Arkansas to qualify they must be both disabled and impoverished, in some cases making less than $108 per month.

That leaves hundreds of thousands of adults, many of whom work full time, without coverage. And that, in turn, creates great financial stress for those adults and their families and tremendous burdens on hospitals, doctors and others who provide emergency care without compensation.

One of the biggest impacts of the Patient Protection & Affordable Care Act is to give states the option of offering Medicaid coverage to those with the lowest incomes. In Arkansas, that would mean providing much-needed access to care for about 250,000 mostly working adults.

The Arkansas Medicaid program is now under great financial strain due to rising health costs. So, it’s reasonable to question whether now is the time to expand, even when so many could benefit. But for a variety of reasons outlined below, it’s becoming increasingly clear that for Arkansas and its citizens, expansion could be a very good deal.

The Affordable Care Act directly helps the Medicaid program in three ways. It offers more federal funding for some existing Medicaid clients, meaning that less state funding is needed. It offers hundreds of millions of dollars in new federal Medicaid funding to cover low-income adults. Lastly, it pays for an increase in reimbursement rates to Arkansas primary care doctors who are the backbone of the state’s Medicaid system.

In addition to these direct effects, there are large secondary benefits:

• The almost $700 million in new federal money that will flow intothe state each year will generate considerable local economic activity, resulting in more state revenue.

• Less state money will be needed for indigent health care. It will provide stability for strugling families and for struggling hospitals and clinics.

• And for most adults needing help from Medicaid, it will mean a much less cumbersome eligibiity process, one that no longer requires reams of medical records and months of waiting to qualify for coverage.

Our state Medicaid Director, Dr. Andy Allison, a health economist by training, recently completed an analysis of the costs and benefits. He found that even when using conservative assumptions, the net benefit of expansion to the state in the first full year totaled $89 million, and over the entire eight years of implementation it netted the state well over $350 million.

Many people have strong feelings, pro or con, about the Affordable Care Act. And, because health care is complicated, often those sentiments are simply applied to the act as a whole. But the act is a collection of many components, and it would be unwise to not look a little deeper. In the case of expanding the Arkansas Medicaid program, the deeper we look, the more it appears that it is good for our families, for our communities and for the state’s budget.

We are in the midst of a major effort to get better value from our Medicaid dollars, and implementing an expansion of this size will be an added challenge. But it also is a huge opportunity to provide real help to real people in our communities. I, for one, hope we take advantage of it.