Medicaid program adds 7,000 to rolls

Arkansas enrollees now top 324,000

More than 7,000 people completed enrollment in Arkansas' expanded Medicaid program in September, bringing the total to more than 324,000, according to figures released Monday.

Those covered under the program as of Sept. 30 included 301,009 who had enrolled in the so-called private option, which uses Medicaid funds to buy coverage for low-income Arkansans in private plans offered on the state's health insurance exchange.

The release of figures -- contained in a letter from state Department of Human Services Director Cindy Gillespie to Gov. Asa Hutchinson -- was the first showing private option enrollment over 300,000 since sign-ups began in 2013.

Those enrolled in expanded Medicaid also included 23,309 people who were being covered under the traditional, fee-for-service Medicaid program because they were considered to be "medically frail," with health needs, such as long-term nursing home care, that private plans typically don't cover.

The total number of Arkansans covered under expanded Medicaid was likely even more than the 324,318 who had completed enrollment as of Sept. 30 because the total didn't appear to include Arkansans who have been determined eligible but have not completed enrollment.

For instance, figures released by the Human Services Department in June showed that as of April 30, more than 292,526 Arkansans had been approved for coverage under expanded Medicaid, but only about 283,396 had completed enrollment.

Even before they have completed enrollment, applicants who have been determined eligible can receive health benefits under Medicaid.

The June report was the last time the department had reported the total number of applicants approved for coverage.

The federal government has been paying the full cost of coverage under expanded Medicaid since 2014, but Arkansas will be responsible for a portion of the cost starting next year.

The state's share will start at 5 percent in 2017, then increase every year until it reaches 10 percent in 2020.

In an application in June to extend the federal waiver authorizing the private option, state officials estimated the cost of the private option in 2017 would be about $79 million and that enrollment would average 246,126.

The application predicted that enrollment would grow to 272,000 by 2021.

Department officials have said that the cost to the state will be offset by reductions in state spending on medical care for the uninsured as well as a reduction in spending in the traditional Medicaid program, for which the state provides about 30 percent of the funding.

The private option also generates tax revenue through a 2 percent state premium tax collected on health plans, including private option plans.

Human Services Department projections in August predicted that the private option will have a positive impact on the state budget until the fiscal year that ends in 2021, when the net cost to the state will be $14.3 million.

Including increased state tax revenue generated by the increased federal spending, the expanded Medicaid program was expected to result in a net benefit to the state even in 2021. The total benefit to the state budget from fiscal 2017 through fiscal 2021 was estimated at $278 million.

Human Services Department spokesman Amy Webb said she didn't have information Monday about the effect of the higher-than-expected enrollment on the cost to the state of expanded Medicaid.

In a Sept. 15 letter, Hutchinson asked Gillespie to develop a "five year outlook" on the state's Medicaid program, including expanded Medicaid and the traditional program covering more than 630,000 Arkansans, by last Saturday.

But Webb said Monday that Human Services Department officials haven't yet given Hutchinson the projections and need more time to develop them.

She said the department plans to present Hutchinson with a look at the past five years of Medicaid spending when he returns on Oct. 21 from a trip to China. The department will provide projections for the next five years sometime after that, she said.

Hutchinson spokesman J.R. Davis said Monday that the governor doesn't have a problem with the delay.

The Sept. 15 letter also asked Gillespie to lead an effort with Insurance Commissioner Allen Kerr and Arkansas Health Insurance Marketplace Director Cheryl Gardner to develop a plan for the "long-term sustainability" of Medicaid, including the traditional program and expanded parts of the program.

The expansion of the state's Medicaid program extended eligibility to adults with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four.

As part of the application to extend the private option waiver, Hutchinson has asked to make changes that he has said will encourage enrollees to stay employed and take responsibility for their health care. Those changes include providing coverage for some enrollees through subsidized, employer-sponsored plans, charging premiums of about $13 to certain enrollees and referring enrollees to job-training programs.

The changes would take effect Jan. 1, when the revamped program would be known as Arkansas Works.

Metro on 10/18/2016

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