Legislators’ goal of Medicaid copays in U.S. plan

Tuesday, January 15, 2013

— New proposed Medicaid rules would allow states to charge co-payments for Medicaid recipients in nonemergency uses of emergency rooms and prescription drugs, the federal government announced Monday.

Copayments for Medicaid recipients have been a major goal of Arkansas Republican lawmakers as legislators grapple with the decision to participate in a federally supported expansion of the health-care program for poor Arkansans.

The expansion, part of the federal Affordable Care Act, would cover individuals making up to 138 percent of the national poverty benchmark, which would add about 250,000 people to the state’s rolls.

Gov. Mike Beebe, a Democrat, was still reviewing the rules late Monday and had no immediate comment on whether the federal action would help or hinder chances of expanding the $5 billion program that already covers about 780,000 Arkansans, said Matt DeCample, his spokesman.

“The governor has said it’s something we’re willing to talk about. Any guidance from [the federal government] helps to frame the discussion. It’s just more information for us, and more information is always a good thing,” DeCample said late Monday.

Arkansas Senate President Pro Tempore Michael Lamoureux, a Russellville Republican, said he wanted to review the rules and discuss them with fellow lawmakers before commenting further.

“The more rules we can get that let us know what our boundaries are, the more theyget resolved, the quicker we can get down to it,” Lamoureux said.

In a letter dated Monday to the National Governors Association, U.S. Department of Health and Human Services Secretary Kathleen Sebelius acknowledged that “Many Governors have articulated an interest in adopting cost-sharing requirements for Medicaid beneficiaries, consistent with models used in the private sector.”

A proposed rule, Sebelius wrote, would allow “cost-sharing” or co-payments for “all income groups” with an emphasis on emergency-room services and prescription drugs. Her agency is proposing that states can charge Medicaid recipients who are at or below 150 percent of the poverty line up to $8 for “non-preferred” prescription drugs.

Nonemergency uses of the ER can be assessed an $8 charge for those at or below 150 percent of poverty. States can charge co-pays without any caps to those above 150 percent of the poverty line - about $34,575 for a family of four or $16,755 for an individual, according to elements contained in the 474-page set of proposed rules.

In her letter to governors, Sebelius said her agency is “committed to provide additional authority and flexibility to states in this area.”

Arkansas Department of Human Services officials were still digesting the news late Monday, said Amy Webb, a department spokesman.

“We’ll just have to sit down and look at the rules and decide what’s best for Arkansas,” Webb said.

Medicaid expansion is the biggest issue facing the Legislature, which convened Monday. For Beebe to succeed in his stated goal, he must persuade 75 House members and 27 senators to vote in favor of enlarging the federal-state program that serves the elderly, the disabled, low-income children and pregnant women. The state program faces a $138 million deficit next July.

Beebe and Department of Human Services officials have said that expanding the program under the Affordable Care Act would avoid the worst of proposed $130 million in Medicaid cuts, including eliminating nursing care for about 15,000 frail senior citizens.

Republicans have countered by saying the projected deficit should be tackled first, perhaps by using a big chunk of an expected $300 million state surplus. They have also promised that nursing care for those elderly won’t be axed.

The federal government has promised to pay for 100 percent of expansion costs until 2017. By 2020, the state would be responsible for 10 percent of the costs.

Department of Human Services officials have estimated that the state would save about $630 million by 2021, mostly through spending far less on the uninsured and increased tax revenue generated by an influx of more than $1 billion in federal revenue each year. Additional dollars would be saved by switching some existing Medicaid populations to the more generous expansion formula.

Also on Monday, Sebelius announced that states that haven’t decided how to run their insurance exchanges will have more time to choose if they want to partner with the federal government - as Arkansas decided to do in December - or let the federal government run their exchanges. The exchanges are designed to be online marketplaces in which consumers can buy health coverage, which will be federally subsidized for families earning up to $92,200.

Front Section, Pages 1 on 01/15/2013