State leaders: Disability policy unwieldy

Bid to rein in Medicaid growth must start with federal changes, they say

— Top officials from the Arkansas Department of Human Services and their state counterparts who handle federal disability claims agree that national policy needs to change if the rapid growth of Arkansas’ disabled on the Medicaid rolls is to be slowed.

Since 2007, costs related to disabled people have accounted for 51 percent of growth in Medicaid spending, and the majority of that population gets Medicaid because the people qualify for Supplemental Security Income, according to figures from the Human Services Department.

Over that time, care for this population has amounted to more than $500 million of the $985 million growth in state Medicaid spending.

Officials with the Human Services Department and the state Disability Determination for Social Security Administration have met twice this month and discussed the increase in the Supplemental Security Income population.

The preliminary discussions have focused on how best to overhaul the way the state’s disability determination office could examine people already on the rolls to see if their conditions have improved enough for them to leave the program.

The discussion among Arthur Boutiette, director of the state’s determination office, Human Services Director John Selig and state Medicaid Director Andy Allison - and a subsequent lunch between Boutiette and Allison last week - was prompted by legislators’ questions raised in a Feb. 3 story in the Arkansas Democrat-Gazette that detailed the rapid grow thin Supplemental Security Income recipients also receiving Medicaid.

“The best thing we can do is to make it crystal clear to people what the problem is,” Boutiette said Friday.

Boutiette’s office determines eligibility on the basis of rules established by Congress and the Social Security Administration.

Federal policy needs to be fixed, Boutiette said, echoing comments Allison made to the newspaper at the beginning of the month.

More people are applying for Supplemental Security Income, a federal cash-benefit program that guarantees almost immediate Medicaid benefits. And state Human Services Department officials say their hands are tied in addressing the growth because they don’t have any role in deciding who gets Supplemental Security Income payments.

State lawmakers have talked with Boutiette about a possible resolution, calling on federal officials to make it easier for the Social Security Administration and the state agency that determines eligibility to review cases and remove people from the rolls if necessary.

And Boutiette said his hope is that a critical mass of resolutions or other actions taken in Arkansas and a number of other states will make the federal government take notice.

But one influential Republican state representative said this week that Statehouse resolutions are often ineffective.

“I’m glad they met,” said John Burris of Harrison,chairman of the House Public Health, Welfare and Labor Committee. “But it’s an uphill battle. Resolutions usually get filed in a drawer someplace.”

Rep. Warwick Sabin, D-Little Rock, and leader of a group of first-term lawmakers, said he plans to ask Boutiette to meet with lawmakers, many of whom had questions about Supplemental Security Income at a Feb. 4 caucus meeting.

“There is a lot of interest in SSI in general, not just related to Medicaid expansion,” Sabin said.

The growth in Arkansas’ disabled population is because more people are applying, Boutiette said. It’s not because the state’s disability determination office is approving a greater share of applications, he said. In fact, its approval rate has stayed relatively the same, and even declined slightly, in recent years, he said.

“I think we have a disproportionate amount of people applying,” Boutiette said of Arkansans seeking Supplemental Security Income and other federal disability benefits as compared with other states.

The growth is evident in Medicaid, according to Human Services Department monthly figures. Since 2007, the number of people eligible for Medicaid because of Supplemental Security Income has grown from 96,420 to 115,323 at the end of 2012. And the largest share of that population is adults under 65.

That growth in Supplemental Security Income claims is troubling, Boutiette said, because once people start receiving Supplemental Security Income checks, they rarely give them up.

“That’s where the problem is - they’re not coming off” the rolls, he said.

Boutiette said his office conducts thorough reviews of disability applications to make sure those who receive benefits actually need them.

“It’s difficult to get on this program,” he said.

But his office could benefit from Congress changing the policy so that his staff could conduct a more stringent eligibility review of the people already receiving disability and better weed out those who no longer need to receive benefits.

Right now, it’s too difficult to remove people from the federal disability rolls, he said.

“If they don’t change the policy, we’ve got some difficult days ahead,” he said.

The discussion of more flexible management of Supplemental Security Income claims comes as Arkansas legislators are debating whether to expand the state’s Medicaid program under the federal Affordable Care Act.

Allison has said expanding Medicaid to up to 138 percent of the federal poverty level, or $15,415 a year for an individual, would help alleviate the Supplemental Security Income crunch because more of beneficiaries would be covered by Medicaid, freeing them to work.

A health-care policy consultant working with Arkansas on aligning benefits in the state’s insurance exchange and Medicaid programs agrees.

“These are people on the fringes. The rules push them to pursue disability and not pursue work,” said Steve Schramm, managing director at Optumas, a health-care policy firm based in Scottsdale, Ariz.

A U.S. Supreme Court ruling on President Barack Obama’s signature healthcare overhaul, the Affordable Care Act, allows states the option of expanding their Medicaid programs.

Gov. Mike Beebe and most Democrats want to expand the rolls by 250,000. Many Republicans oppose that or are undecided.

Expansion needs 75 votes in the House and 27 in the Senate to be approved. Both chambers are controlled by the GOP.

Recently, Republican leaders have suggested that the issue not be taken up until next year. Beebe said lawmakers should decide during this legislative session whether to expand Medicaid.

If the state does expand, Schramm said, it has implications for the Supplemental Security Income-linked Medicaid population.

“It will incentivize them to pursue the Medicaid process as opposed to sit on the sideline and collect disability,” Schramm said.

Advocates for the developmentally disabled said they are concerned that attention paid to the growth in Supplemental Security Income claims unfairly targets children and adults who need Medicaid services.

Programs serving the developmentally disabled population haven’t experienced the same level of growth as other segments of the Supplemental Security Income population, they said.

“Anytime you look at this type of data, you have to look behind the numbers,” according to a statement from the Developmental Disabilities Provider Association. “If the state wants to eliminate growth, especially for one of the most vulnerable populations, children and adults with developmental disabilities, it will have very serious consequences.”

Allison and Boutiette have said they have no interest in kicking people off Supplemental Security Income who genuinely need services.

Expanding Medicaid would also help the state’s finances, Schramm said. The new health-care law allows people who might have qualified as disabled to receive Medicaid without needing federal disability status. And the federal government would pay every Medicaid dollar spent on them until 2017. After that, the state’s share would gradually increase to 10 percent by 2020.

If Arkansas doesn’t expand Medicaid?

“Then we don’t need to be having this conversation,” Schramm told insurance exchange planners in Little Rock earlier this month.

Selig and Allison wanted to meet with Boutiette to learn more about Supplemental Security Income. They plan to continue talking, said Amy Webb, Department of Human Services spokesman.

Front Section, Pages 1 on 02/17/2013

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