Arkansas is seeking a two-year reprieve from the federal government after the initial request for Arkansas' Medicaid expansion renewal was verbally denied. This denial could affect more than 200,000 Arkansans. Ozarks at Large's Aiden Dixon has more.
Arkansas' Medicaid expansion program, called ARHOME, operates a little differently than standard Medicaid. ARHOME directs Medicaid dollars into privately insuring the beneficiaries of the program. We were actually the first state in the nation to use this private option.
Camille Richoux, the health policy director at Arkansas Advocates for Children and Families, says Arkansas developed this novel approach as an alternative to traditional Medicaid.
"We were trying to find a solution that would kind of be bipartisan and work and make sure that we expanded. And so we've had this for more than 10 years now, and it has been enormously beneficial. So we sort of purchase plans on the marketplace for our Medicaid expansion population. So originally it was called the private option and then Arkansas Works and now ARHOME, but they're all the same thing. They're still providing insurance, just in a different way."
This program, by all accounts, has been hugely beneficial for large swaths of Arkansans. It's this exact reason why Richoux stresses that the stakes are so high.
"Arkansas cut its uninsurance rate among adults nearly in half from 2013 to 2014. Hospitals saw 55% drop in uncompensated care costs. And those are rippling effects around the community. And we also get a really good deal for our Medicaid expansion. And the federal government pays 90% of the cost of this program. And we pick up the other 10%. So those federal dollars flow into hospitals, clinics, pharmacies, medical practices around the state. They support jobs. They strengthen local economies. And then also Arkansas families get the health care that they need to stay healthy, to care for their families, to work to thrive. So everybody is impacted by what happens with our Medicaid expansion."
Now, Richoux clarifies that the denial of the ARHOME waiver doesn't mean Medicaid expansion in Arkansas completely disappears. She says that the real question becomes, what does the expansion come to look like after ARHOME?
"The kind of worst case scenario is that this population of adults, this is non-elderly adults. And the expansion population would probably fall into traditional Medicaid and what's called fee-for-service while we kind of figure out what to do next.
"But the really kind of important thing, at least for enrollees, for beneficiaries, for families in Arkansas, is that it's a really confusing time. There are already all of these new administrative requirements with work reporting requirements that are coming to this population with shortened renewal periods. So going from one year to six months, having to reapply. And now the confusion of letters that they're getting and messages that they're getting that their insurance is changing and this program may not exist. It's just a really confusing time. Especially if you're someone who needs health care, which hundreds of thousands of Arkansans do."
This uncertainty is part of why Arkansas is requesting the two-year reprieve. There are actually several different paths Arkansas could go down, which is why Richoux says that transitioning from a program that has been around for over a decade will take some time.
"If this was not built overnight, ARHOME, the private option, was not built overnight, and figuring out what comes next is also not going to take place overnight. We could resubmit a waiver with some changes that are maybe smaller that could get it approved to kind of keep our similar expansion, or we could completely change the way our expansion works. And since we do ours differently, we could align ours more like the other states that do it. Forty states have expanded Medicaid and 33 of them do it through managed care. There are just some different ways that we could do our expansion moving forward to make it more sustainable.
"And so that two-year extension is going to be really important to figuring out and doing it right. Our legislative session is next year, so it's going to be a lot of conversations with elected officials on how we're going to maintain our expansion. And then we've got our fiscal session in the following year. So that two year really gives us enough of a ramp to make sure that we have this continuity of our program that people aren't falling through the cracks and that big changes that affect people's lives aren't haphazardly thrown together or people aren't harmed in this process."
For Richoux, the conversation around ARHOME is bigger than just transition from one program to another. It's really about what the transition could mean for health care around the state.
"What happens in the coming months are going to determine what happens to hundreds of thousands of Arkansans' health care, to make sure that they can continue to access care when they need it, whether rural hospitals can remain open and whether the state continues building on more of a decade of progress."
We reached out to the Arkansas Department of Human Services for comment or a statement on the status of Medicaid expansion in Arkansas. They provided a copy of the letter they sent to the Centers for Medicare and Medicaid Services asking for the two-year extension, but did not provide further comment or statement.
