Republicans urge 2nd look at Medicaid

GOP doesn’t want blame if nursing homes feel cuts

Lawmakers who don’t want to expand Medicaid coverage fear they’ll bear the blame if nursing care for frail seniors is slashed.

They’re wondering if money can be saved by cutting Medicaid services for other Arkansans, including pregnant women, the mentally ill and those with discounted drug prescriptions.

They voiced their concerns to a subpanel of the Arkansas Legislative Council on Tuesday in Little Rock.

Some Republicans suggested that proposed Medicaid cuts for up to 15,000 Level 3 nursing care recipients might have been chosen to bolster Gov. Mike Beebe’s bid to expand the program by 250,000 people - a charge strongly denied by the state’s Medicaid director. Level 3 nursing care recipients are those needing significant care to eat, walkand use the bathroom.

The Human Services subcommittee conditionally approved the Department of Human Services’ plan after an hour of debate.

Lawmakers expressed concern that the public would blame them for making unpopular cuts to the state’s $5 billion program.

“If we don’t give you and the administration the funding that you’re going for, it’sgoing to become our fault as legislators for putting 15,000 nursing-home residents out on the street,” said Rep. Kim Hammer, a Benton Republican.

“It is a straightforward and certainly undesirable recommendation so that we are not committed to a program that we cannot fund,” replied Andy Allison, state Medicaid director.

Some Republicans have wondered if the $143 million in planned cuts are the only possible reductions to close a $138 million deficit in the program estimated for July 2013. Medicaid covers about 780,000 of the state’s poor, elderly and disabled residents, along with low-income children. Federal law prohibits eliminating many Medicaid services, leaving Level 3 nursing care as the most viable option, Allison said.

On Tuesday, GOP members of the Human Services Subcommittee dominated the questioning, pushing Allison to clarify if other “optional” Medicaid services could be slashed instead. Prescription drug services, children’s programs, mentalhealth care, even gastrointestinal bypass surgery, were raised by Republicans seeking more information about alternative cuts.

Using community-based mental health care as an ex-ample, Allison said cuts to that service would endanger individuals, families and others as patients rapidly degenerated, becoming unstable. He said that any money saved by cutting those services would add greater costs to law enforcement, hospitals and other institutions.

“In purely financial terms, it’s not a very efficient reduction,” Allison said.

Debra Hobbs, a Rogers Republican, said fathers - regardless of whether they live with the women they impregnated - should be asked to chip in.

“Obviously, there is a father somewhere. But we’re not asking the father to pay anything or look at his assets?” Hobbs said.

Allison said that, legally, the father’s financial liability is determined through the court system - not the Medicaid program.

Hobbs said she thought targeting the elderly and developmentally disabled was misguided and that children should not be excluded from possible cuts.

“I understand children taking priority but I also understand that a lot of those children have parents that should be the ones with that first primary responsibility versus the state,” Hobbs said.

Cuts to children’s health programs, such as the “optional” ARKids Part B, which provides health coverage for children in families earning up to 200 percent of the poverty level, are prohibited by the new federal health-care law until 2019. The law also bans any cuts to Level 3 nursing care until January 2014.

ARKids B covers about77,000 Arkansas children.

Sen. Missy Irvin, R-Mountain View, said Allison’s argument about cost-shifting could also be employed to argue against getting rid of Level 3 nursing care. She asked if any consideration had been given to the pricetag for hospitals and adult protective services or the economic damage caused by nursing home closures.

About half the Level 3 population lives in nursing homes. Nursing home industry officials have said up to 90 facilities, mostly in rural areas of the state, would shutter their doors if they lose Level 3 funding.

“When we discuss closing Level 3 nursing care, we’re really, really, really teetering on a line of being very irresponsible,” Irvin said.

Irvin said she didn’t know if she believed that nursing care cuts are the only option.

Allison said he shared Irvin’s concern for the “sanctity of life,” but said the state didn’t have any other way to close the deficit. He said repeatedly that the elimination of Level 3 care, the biggest single reduction in $329 million in proposed reductions, freezes and eliminations in the program in the next two fiscal years, could be avoided if lawmakers agree to expand Medicaid.

Under the Patient Protection and Affordable Care Act, states have an option to cover residents earning up to 138 percent of poverty.Republicans have largely been opposed to expanding the rolls in January 2014. On Tuesday, several GOP lawmakers questioned whether the federal commitment to cover 100 percent of expansion costs until 2017 would remain in place in light of a looming national debt crisis.

Allison said the federal money is part of the law, but acknowledged that Congress and the president could change the law.

Rep. Stephanie Malone, a Fort Smith Republican, asked how many Medicaid recipients had received gastric bypass surgery, used for weight loss. She also requested a list of states that required Medicaid recipients to pay copays.

Republicans have said they want an overhaul of the existing Medicaid program, including requiring copayments and drug tests, before agreeing to any expansion.Republican leaders had advocated for a “partial” expansion covering a smaller group of Arkansans, but the federal government announced last week that it would not pay for anything less than coverage up to 138 percent of poverty. Seventy-five House members and 27 Senators are needed to approve expansion. Republicans now hold51 seats in the House and 21 Senate slots.

Malone expressed skepticism that expanding the Medicaid rolls would save the state $159 million.

“Expansion and savings: Those don’t always seem to go together,” Malone said.

Democrats said expansion would help rural hospitals and nursing homes. And they said expansion would solve the problem of forcing seniors out of nursing homes or removing their home health-care workers.

“We don’t have any alternative. We’re not sending those people home,” said Sen. Randy Laverty, D-Jasper. Gesturing to a group of Republicans nearby, Laverty, who is leaving the Senate because of term limits, said:“Those of you who are returning down yonder. Make special note of this.”

Shortly after Laverty finished speaking, Malone retorted: “I tend to tune [Laverty] out when he talks for a long period of time.”

Northwest Arkansas, Pages 7 on 12/19/2012

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