State fears U.S. site will fail Medicaid-shorn Arkansans

The chairman of a state insurance board said Thursday that he's concerned about whether federal officials will leave themselves enough time to implement changes Arkansas hopes to make to its expanded Medicaid program.

At a meeting of the state Legislative Council's Arkansas Health Insurance Marketplace Oversight Subcommittee, Mike Castleberry noted that the federal government's website, healthcare.gov, was plagued by technical glitches when enrollment through the site started on Oct. 1, 2013.

If the federal government approves Arkansas' request to shrink its expanded Medicaid program, many of the 60,000 people who are moved off the program are expected to turn to the federal website to find other coverage.

Castleberry said he worries that the site won't function properly on Jan. 1 if federal officials wait until "the last minute" to approve Arkansas' requested changes, which would require modifications to the website.

"I'll be the first to say with our history with the [federal enrollment system], I'm not sure they'll be ready," Castleberry, chairman of the Arkansas Health Insurance Marketplace board of directors, said.

"I feel like it will be a problem, and we'll be the ones left to take those phone calls."

Under a plan proposed by Gov. Asa Hutchinson and endorsed by the Legislature during a special session this year, Arkansas would limit eligibility for its expanded Medicaid program, known as Arkansas Works, to adults with incomes of up to the poverty level, instead of 138 percent of the poverty level.

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Starting Jan. 1, the state would begin moving those affected off Arkansas Works at a rate of about 5,000 people a month.

Many of those who lose Medicaid coverage are expected to qualify for federal tax credit subsidies to help them buy private coverage through healthcare.gov.

But that would require changes to the federal site. Currently, most Arkansans with incomes below 138 percent of the poverty level don't qualify for the tax credits because they are eligible for Medicaid.

Amy Webb, a spokesman for the state Department of Human Services, said state officials expect to receive approval for the change in September or early October.

She said in an email that the required change is a "simple one, but when you make changes with large IT systems [there] can be issues, as we've seen, so we understand" the concern.

She said the department will work with federal officials "to ensure there is as smooth a transition as possible."

The Legislature created the marketplace in 2013 to set up state-run health insurance exchanges allowing individual consumers and small businesses to shop for coverage and apply for subsidies created under the 2010 federal Patient Protection and Affordable Care Act.

The marketplace set up the small-business exchange in 2015, but, at Hutchinson's request, scrapped its plan to establish an enrollment system for individual consumers.

Instead, the agency took over responsibility for certifying the plans offered through healthcare.gov and providing information to consumers.

Meanwhile, Arkansas Blue Cross and Blue Shield, the sole insurer offering plans on the small-business exchange, plans to stop participating in that exchange next year.

State Insurance Commissioner Allen Kerr told the oversight subcommittee that his department could save consumers millions of dollars by taking over responsibility for the exchanges from the marketplace starting in 2019.

Kerr said the Insurance Department's cost to run the individual exchange would be less than $1 million, compared with about $4.4 million that the marketplace expects to spend on its own operations in 2019.

But Kerr said that would involve reducing spending on activities such as promoting enrollment through television and radio commercials.

"We're going to pare this down to what's absolutely necessary," Kerr said.

Kerr added that, under current state law, the department would not be able to take over responsibility for employing outreach workers, known as navigators, which the Affordable Care Act requires exchanges to have.

Special language that has been attached to state appropriation bills since 2014 bars the state Insurance, Human Services and Health departments from employing navigators or promoting enrollment in the exchange.

Money for the marketplace's operations comes from a fee equal to 3 percent of the premiums for non-Medicaid plans sold on the exchanges.

This year, the marketplace expects to collect $10.3 million from the fee, with half going to the federal government for the use of healthcare.gov.

Rep. Deborah Ferguson, D-West Memphis and a co-chairman of the subcommittee, said she'll seek an independent review of the potential savings from moving responsibility for the exchanges to the Insurance Department. But she said she'd be concerned if the move means offering less help to consumers.

"For people who've never had health care before, it's a complicated world," she said.

A Section on 08/18/2017

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