States talk Medicaid growth

Arkansas among presenters at legislative conference

Debbie Wilkinson (left), wife of Georgia state Sen. John Wilkinson, and Amy M. Bailey pack meals while volunteering with the Arkansas Hunger Relief Alliance on Sunday at the Statehouse Convention Center during the Southern Legislative Conference.
Debbie Wilkinson (left), wife of Georgia state Sen. John Wilkinson, and Amy M. Bailey pack meals while volunteering with the Arkansas Hunger Relief Alliance on Sunday at the Statehouse Convention Center during the Southern Legislative Conference.

Legislators from across the South squeezed into a small ballroom at the Marriott Hotel in downtown Little Rock on Sunday to hear how three states, including Arkansas, approached their Medicaid expansion plans.

During the second day of the Southern Legislative Conference, dozens of legislators attended a session on how Arkansas, Kentucky and West Virginia designed ways to expand their Medicaid programs. Many legislators had expressed interest in the session, including those from states where the legislatures are still considering whether to expand their health care programs and how those expansions would look.

The three states chosen to present were early adopters of expansion, but the three designed very different programs. Representatives of all three states said it's still early in the programs, so the results aren't complete. But so far, the three said the programs have worked better than expected.

In West Virginia, the program was a true Medicaid expansion. The state has a higher-than-average number of disabled residents and some of the highest death rates in the country because of health issues such as heart disease and cancer, said Jeremiah Samples, deputy secretary of public insurance and strategic planning for West Virginia.

"Few states have these types of demographics," he said. "There are challenges for us that other states don't have to deal with. It's a serious situation and something that we are perpetually trying to address."

Because of those health factors, Samples said, even after the U.S. Supreme Court ruled that the federal government could not mandate that states expand their Medicaid programs, West Virginia's governor pushed forward with the expansion. He said an actuarial study underestimated the number of people who would sign up for the program, predicting about 91,500 people would sign up for Medicaid by 2016.

As of July 14, Samples said, 134,278 people had signed up.

He said continuing the program depends on fully implementing a managed-care approach instead of a fee-for-service model, everyone paying copays across the board and the federal government continuing to fund its match for the program.

In Kentucky, the expansion was a broad approach that expanded traditional Medicaid but also increased private health care options, said Eric Friedlander, the deputy secretary of Kentucky's Cabinet for Health and Family Services.

The state was able to capitalize on an existing health care exchange. Kentucky had little to no problems with the technology portion of the rollout, but much like West Virginia, had an unexpected amount of people sign up for the program.

"It was a tremendous surge in enrollment," Friedlander said. "We were shocked ... we've signed up 90 [percent] to 95 percent of people we thought were eligible."

He said the early surge is proving beneficial for the state and the health care providers, because the federal government is still reimbursing 100 percent of the health care costs for new enrollees. Kentucky has also pushed to get about 80 percent of its expansion enrollees in a managed-care program, instead of traditional fee for service.

"When you break it down ... the more people in the system earlier, the more economic sense it makes," he said.

Many people without health insurance had a pent-up need for medical care, which could be more expensive to address when they first enter the system. By the time the federal subsidy is reduced to 90 percent, Friedlander said, many patients will have addressed their most expensive needs.

In Arkansas, Andy Allison, the former Medicaid director, said the state's Legislature took the opportunity to transform insurance marketplaces and make sure the traditional Medicaid system was being used as it was intended.

In his view, Allison said, Arkansas' private-option program did not actually expand Medicaid, because the Medicaid rules do not apply to the new enrollees in the private health insurance plans.

"Legislators asked several questions when we were working to figure out what this would look like," Allison said. "Can we shrink Medicaid and grow the private insurance marketplace? Can we promote personal responsibility?"

He said the independent health savings accounts that are a planned requirement in the next year will address personal responsibility for health care needs. Legislators also asked that whatever expansion took place, it would attract more insurance carriers and competition. They also wanted a plan that would consider continuation of care because of the "churning" that happens in the population eligible for the expanded services -- those between 17 percent and 138 percent of the federal poverty level.

"Do not be surprised if Arkansas' insurance marketplace is the most competitive for a state its size in the country in history," Allison said.

Several Arkansas state senators and representatives nodded their heads as Allison talked about the program and his predictions for its success. But the future of the program has been in question almost since it began.

The May primary and June runoff elections dislodged several supporters in tight races that could mean a legislative hurdle to the supermajority needed to continue funding the program. Arkansas requires three-fourths, or 27 of the 35 senators and 75 of the 100 representatives, to pass appropriations bills.

Allison, who stepped down June 1, said he believes that the program will be successful and "seen for what it really is." He argued that it was not a political compromise but a way to reach common goals set up by legislators to improve private health care access in the state.

The legislative conference, which is held in a different city each year, will run through Tuesday at the Little Rock Convention Center and the Marriott Hotel.

Metro on 07/28/2014

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