Roby Brock: Welcome to this edition of the Northwest Arkansas Business Journal Report. I'm your host, Roby Brock. Janet Mann has been tapped by Gov. Sarah Sanders to lead the Arkansas Department of Human Services. She's been the state Medicaid director for many years, and she's got a variety of experience on a number of healthcare topics. She and I will sit down today on the Northwest Arkansas Business Journal Report.
Our first guest this week has been on the show several times, as Medicaid changes and policies to improve Arkansas's maternal health statistics have been front and center. But she's here with a different role today. She's Janet Mann. She was named by Gov. Sarah Sanders as the new secretary of the Department of Human Services. Congratulations and thank you for being here.
Janet Mann: Happy to be here.
Brock: You having fun in the new role yet?
Mann: Yeah.
Brock: Is it different than the old role?
Mann: It is different from the old role. I'm super excited to be secretary, but, you know, changing from the deputy and the Medicaid director to the secretary... Now, I have to be a little more higher up in training and transfer and delegate and ask people to say, 'Hey, what's going on?' versus 'This is what we're going to get done'. But I still get to say, 'This is what we're going to get done'. It's just a little bit different.
Brock: What are you going to do differently than maybe your predecessor or predecessors? Do you have some thoughts on some different directions?
Mann: I do. I think first and foremost we need to continue some on of the momentum we started with maternal health. We've moved into the implementation mode. We had a bill that the governor proposed and the legislature passed and she signed. So now we have moved into the implementation of maternal health. And now taking those results as they come month by month and really seeing what's happening and driving future decisions.
We're also going to still continue to focus on behavioral health, really with an emphasis on children and school-aged children. Another piece that's very important is children before they go to school. So what can we do there? We have several pilots going and really want to use those evidence-based outcomes to drive better decisions and better programs.
In addition, work requirements. We've been working on it for several years. We have a pending waiver, and now we are into implementation and going live. The team is working really hard. Given what was passed in the budget bill at Capitol Hill, signed by the president, we already had a pending waiver amendment requesting to do that. So now we will reconcile those two documents and then come forward with work requirements on or before Jan. 1, 2027, which is the required deadline date.
Brock: That's probably one of the biggest things from the budget bill that you'll be dealing with—these changes to Medicaid and the SNAP program. We're going to talk about both of those things eventually. But what's going to be different about the work requirements this time that you think will make it more successful than it was last time?
Mann: I think the biggest piece is going to be the federal legislation that allows work requirements to exist. So we will be able to implement and have those work requirements, and then we will work with CMS on the terms and conditions of what those look like. The budget bill calls for 20 hours a week or 80 hours a month. We will be working on that.
I think we're going to still use a lot of what we proposed with reporting of all types and then exceptions. We really want to focus on the administrative process of matching work requirements through electronic means, but make it easier for the beneficiary to report and know what they're doing. We'll have to work out some details on the volunteering and caretaking piece because we will have lots of data matches we can use for people going to work, people going to school, and doing different things. We'll work through those logistics on how we do reporting.
We also had a piece in our amendment that was different from the bill on success coaching. If the beneficiary wants additional guidance and help on how to move up and off of Medicaid onto hopefully employee-sponsored healthcare or further into the marketplace for healthcare, we will work on that piece probably as phase two.
Brock: I don't have to tell you you're going to be juggling a lot of balls in the air, not just those pieces of implementation from the federal bill and state law which you've made some changes for, but you've got skyrocketing health insurance premiums. There's a lot of uncertainty and turmoil in insurance markets right now, and that's going to affect Medicaid in a big way. How are you preparing, adapting, knowing what's coming? I don't know if you can predict everything that's coming.
Mann: We can't predict everything. But we took steps in the last session with our Medicaid expansion population, and we'll be seeking a new waiver with CMS that will be new on Jan. 1, 2027. Some of those ways to help with those skyrocketing costs: we worked with the carriers for pharmacy rebates to come back to the state and the federal government. We worked on the medical loss ratio, which really means they have to spend a percentage of what they're paid as a premium on medical claims. We're working with carriers and the federal government to increase that to 85%, so that more money is spent on healthcare claims to try to help that. We're looking at a few other administrative things to handle what we know. But the unexpected, we will have to pivot when that occurs. I can plan for some things but not everything.
Brock: You've heard the concerns from the healthcare community, the hospital community, the end-user community about changes having this effect— driving up more people not having insurance, going to hospitals for uncompensated care. We've seen this happen in Arkansas before. We've seen it come down because of the changes. What are the metrics you're going to be watching to know what's working policy-wise? I mean, I know you can't go through every metric, but I mean, what are some big things that you're going to be watching that's going to give you some degree of certainty that something's working or something's not working.
Mann: I think one of the biggest metrics we will watch will be enrollment in the expansion population and in traditional Medicaid. One thing I like about Arkansas is with being an expansion state and having no gap in coverage, we're trying to keep uncompensated care low. If we see a big drop in the expansion population, then what is happening? Is the economy growing and people going to work, or is something else occurring we need to be mindful of? And we always have good relationships and communication with providers, hospitals, and others to talk about uncompensated care. But the big thing with the budget bill is the two things I just mentioned: eligibility was not cut. So no eligibility changes, no changes in our FMAP.
Brock: What is FMAP for people that don't know?
Mann: The federal participation rate. We get a nice chunk of change from the federal government with our Medicaid program.
Also, the state's going to receive up to about $500 million over five years on the Rural Transformation Healthcare Fund. We are busy with entities statewide, providers, and others working on how to implement that. It will be an application process. We don't have the guidance on yet, but we're already building the baseline of metrics and things. Using that money to look at what we're going to do in rural Arkansas to help healthcare, to hopefully mitigate some of the unknown and some of the known rising costs.
Brock: That's Janet Mann, the new Arkansas secretary of the Department of Human Services. You can catch our full interview online.
That's all for this edition of the Northwest Arkansas Business Journal Report. I'm your host, Roby Brock. We'll see you next time.
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