More than 14,000 people were approved for coverage under Arkansas' expanded Medicaid program last month, bringing the total to more than 170,000 as of April 30, the state Department of Human Services announced Tuesday.
Meanwhile, at a joint meeting of the state House and Senate public health committees, Sen. Stephanie Flowers, D-Pine Bluff, continued to question why Medicaid-funded health plans offering dental and vision benefits under the so-called private option are available in some parts of the state but not others, including in her district.
Flowers said that had she known about the additional benefits in some plans, "I don't know that I would have supported the private option."
"I feel like there has been a breach of trust by some agency," she said.
State Medicaid Director Andy Allison said officials with the Human Services Department didn't know about the additional benefits offered by some plans until after enrollment started Oct. 1.
He attributed the oversight to the challenges involved in applying for federal approval of the private option at the same time that the state Insurance Department and U.S. Department of Health and Human Services were implementing the health-insurance exchange, on which the Medicaid-funded plans are offered.
Gov. Mike Beebe signed legislation authorizing the private option on April 23, 2013. The federal Centers for Medicare and Medicaid Services granted the state a waiver authorizing the program on Sept. 27, months after insurance companies had submitted to the Insurance Department the details of the plans they are offering on the exchange.
"We had two different trains going at the same time, building the tracks at the same time," Allison said.
Starting Jan. 1, 2015, plans available through the private option will contain only the benefits required by the federal Patient Protection and Affordable Care Act, and those required benefits don't include adult vision and dental coverage, state officials have said.
The expansion of the state's Medicaid program, approved by the Legislature last year, extended eligibility to adults with incomes of up to 138 percent of the poverty level -- $16,105 for an individual, for instance, or $32,913 for a family of four.
Of those who had been approved for coverage as of April 30, 143,447 were enrolled in plans on the insurance exchange under the private option, while 18,561 had been assigned to the traditional Medicaid program because their health needs were considered exceptional.
More than 8,000 other applicants had been approved for coverage but had not yet completed enrollment. An estimated 250,000 Arkansans are eligible for coverage under the expanded program.
Of the four companies offering plans on the exchange, St. Louis-based Centene Corp. is the only one that included adult vision and dental benefits in some of its comprehensive medical plans available to private-option enrollees.
Of the seven coverage areas delineated by the Insurance Department, Centene is offering plans in three -- the central, northwest and west central areas, encompassing 29 of the state's 75 counties.
Under the private option, the state Medicaid program pays the full premium for the plans, but the enrollee in some cases must make co-payments associated with the vision and dental benefits.
Flowers noted that the Centene plans, marketed under the name Ambetter Arkansas, are available to some residents represented by legislators who opposed the private option, but aren't available in the southern and eastern parts of the state represented by legislators who were more supportive.
Although news outlets, including the Arkansas Democrat-Gazette, reported at least as early as Nov. 6 that the plans with dental and vision benefits were available to private-option enrollees, Flowers said she didn't find that out until after this year's fiscal session ended March 19.
At a hearing later that month, Allison told the Legislature's public health committees that the vision and dental benefits were one reason the costs for the private option were running above projections.
Human Services Department spokesman Kate Luck said in an email that department officials expected premiums for the plans to only include the benefits required by the federal health-care law, but "neither the federal rate review process nor plan guidance issued jointly by [the Human Services and Insurance departments] clearly established this requirement, leading to the unanticipated inclusion of added benefits that are reflected in higher premiums in 2014."
As of March 30, only 8,358 of the more than 120,000 people enrolled in the private option at that time had selected plans that included dental and vision benefits, Human Services Department spokesman Amy Webb said. She didn't have an updated total Tuesday.
An analysis by Scottsdale, Ariz.-based Optumas, a consultant to the department, found that a higher-than-expected average age of enrollees is the main reason that costs have been above projections -- about $496 per enrollee per month in May, compared with a monthly cost of $477.63 predicted by the firm last fall.
The terms of the federal waiver that created the private option limit what the federal government will pay for the coverage, but department officials have said the state can ask that the limits be raised to reflect factors such as demographics different from what was projected for enrollees.
In response to questions from Flowers, Insurance Commissioner Jay Bradford said that discontinuing the plans with vision and dental benefits before 2015 would create a "terrific burden on the consumer" and would be a "clerical nightmare."
Rep. Charlotte Douglas, R-Alma, who opposed the private option, asked whether the vision and dental benefits could be made available to residents of additional coverage areas in future years on a rotating basis.
Human Services Department Director John Selig said he "would not feel comfortable adding a benefit unless we were sure we could afford it" or the state passed legislation requiring it to be included.
"Otherwise I think we would put ourselves at risk, or we would then feel less comfortable" that the state will stay within the spending limits set out in the terms of the waiver, Selig said.
A Section on 05/28/2014