State OKs top 155,000 to get Medicaid aid

As March waned, tally rose nearly 6,000 for coverage

The number of Arkansans approved for coverage under the state’s expanded Medicaid program increased by just over 5,900 during the last nine days of March, bringing the total number approved to more than 155,000, according to figures released Monday by the state Department of Human Services.

The total who had been approved for coverage as of March 31 included 121,442 people who were receiving coverage through private, Medicaid-funded plans on the state’s health-insurance exchange and 16,783 who were assigned to the traditional, fee-for-service Medicaid program because they were considered to have exceptional health needs.

The remaining 17,342 applicants were approved for coverage but had not yet completed enrollment.

Human Services Department spokesman Amy Webb said the pace of the sign-ups continues to exceed officials’ expectations.

“Just anecdotally, we’re hearing that there was just a great need and people didn’t want to pass up the opportunity” to get coverage, Webb said.

Authorized under the 2010 federal health-care overhaul law and approved by the Legislature last year, the expansion of the Medicaid program extended coverage to adults with incomes of up to 138 percent of the federal poverty level - for example, $16,105 for an individual and $32,913 for a family of four.

An estimated 250,000 Arkansans became eligible for coverage that began Jan. 1. Enrollment started Oct. 1.

Under the state’s so-called private option, most Arkansans who qualify receive coverage through private plans on the state’s insurance exchange, with Medicaid paying the premium and providing additional subsidies to reduce or eliminate any required out-of-pocket spending for medical care.

Those with health needs that are considered exceptional are assigned to the traditional Medicaid program.

While open enrollment in plans on the exchange ended for most people on March 31, those who qualify for Medicaid can apply throughout the year.

Of those who had been approved for coverage as of March 31, at least 122,882, or about 79 percent of the total, had incomes at or below 100 percent of the poverty level, meaning they would not have qualified for federally subsidized coverage on the insurance exchange if Arkansas had not expanded its Medicaid program.

The Human Services Department didn’t have information on the poverty level of 5,164 applicants who had been approved for coverage.

Webb said those were likely applicants who had been approved by the federal Centers for Medicare and Medicaid Services but for whom the Human Services Department did not yet have complete information.

Medicaid officials have said the average age of those enrolling in the private option has been higher than expected, leading to the state paying higher-than-expected premiums.

But compared with others who have enrolled for coverage on the health-insurance exchange, those who have enrolled through the private option have tended to be younger.

According to the figures released Monday, 43 percent of those approved for coverage under the expanded Medicaid program as of March 31 were ages 34 or younger. By comparison, the figure is 28 percent for non-Medicaid enrollees who had signed up for plans on the exchange as of March 24, the latest date for which demographic information on the non-Medicaid enrollees was available.

Insurance companies are required to include private option and non-Medicaid enrollees in the same risk pool, meaning their medical costs will be used to calculate future premiums.

“The average age and sheer number of people in the Private Option will have a significant impact on the competitiveness and strength the state’s insurance market moving forward,” Medicaid Director Andy Allison said in a news release.

Out of the 121,442 Arkansans enrolled in plans under the private option, 44 percent selected their own plan, while the rest were automatically assigned to one. Applicants are automatically assigned to a plan if they fail to choose one within 12 days of being approved for coverage.

After an applicant is automatically assigned to a plan, he has 30 days in which he can switch to a different plan if he chooses.

Of the applicants who had not yet completed enrollment, 12,603 had been assigned to a plan but were being covered under the traditional Medicaid program because they still had time left to switch plans.

Applicants who are approved for coverage are covered by the traditional Medicaid program until receiving a final plan assignment.

Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield, one of four companies offering plans on the exchange, said overall enrollment through the health-insurance exchange is below what the company expected, even when the private-option enrollment is included.

As of March 24, 38,441 Arkansans who did not qualify for Medicaid were enrolled in plans on the exchange, including 10,940 who had not yet paid their first month’s premium, which is required before the coverage takes effect, according to the Arkansas Insurance Department.

In addition, about 2,900 plans had been canceled. In some cases, a plan could be canceled because an enrollee decided to switch to a different plan, Insurance Department spokesman Heather Haywood said.

Greenwood added that some of the early claims submitted by private-option enrollees were expensive.

“There obviously are people with very substantial healthcare needs that are now being addressed,” Greenwood said.

Front Section, Pages 1 on 04/22/2014

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