Posted 8/7/2013 07:38 am
Updated 8 months ago
LITTLE ROCK - The Arkansas Department of Human Services on Tuesday submitted a waiver application to the federal government so it can fund private insurance for about 225,000 people to be covered under an expansion of the state Medicaid program.
The program is part of President Barack Obama's health overhaul and is the result of a compromise among Arkansas legislators, who opposed simply expanding the Medicaid program.
Legislators approved using three years of federal funding for expanding Medicaid to pay for private insurance for people newly covered under the expansion. Eligibility will depend on income and the number of people in a household and some will have to pay for part of their health care themselves.
Open enrollment is scheduled to start Oct. 1. The state and insurers have organized informational meetings for businesses and individuals about the changes. The program is spending $24 million on marketing to show state residents how to enroll. State insurance officials said earlier they anticipate a total of 500,000 people will sign up for insurance through the marketplace exchange.
The state's insurance marketplace is to operate as a partnership with the federal government.
The federal government is to be responsible for areas that include eligibility determinations, enrollment of individuals and operating a call center. The state will determine criteria for certifying health insurance plans, monitoring plans for continued participating, providing direct consumer outreach and education and providing consumer complaint resolution.
People who have complex medical conditions or are categorized as medically frail are to be covered under the traditional Medicaid program, Gov. Mike Beebe said in a cover letter to the 64-page waiver application.
DHS spokeswoman Amy Webb said the application addresses concerns over losing funding by Community Health Centers that operate across the state.
"They will continue to get the enhanced rate," Webb said.
Language in the application leaves open the long-term issue of payments for the centers. For the time being, the centers will negotiate rates with insurance companies and the DHS will make supplemental payments to the centers until an alternative payment method is developed.
Executives from a number of centers said at a legislative hearing last month that any loss of funding would translate to patients who couldn't be treated.
Webb said DHS officials worked with federal regulators to develop the portion of the waiver application that deals with the health centers.
The application also includes a provision that mandates notifying the state if a recipient has an increase in income.
"They're obligated to tell us if they have a change in circumstances," Webb said.
Originally the plan was to insure a recipient for 12 months. The time span could be shortened if a person receives a cash windfall or gets a better paying job.
(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, rewritten, broadcast or distributed.)