Arkansas Governor Asks Feds To Explore Medicaid Expansion Changes

Jan 4, 2016

Governor Asa Hutchinson (left) and DHS Director John Selig presenting changes to Medicaid expansion in December.
Credit Jacob Kauffman / KUAR News

As expected the governor of Arkansas is asking federal officials to consider changes to the state's version of Medicaid expansion. 

Republican Governor Asa Hutchinson's office on Monday released a copy of the letter he sent to US Health and Human Services Secretary Sylvia Burwell announcing he's seeking a waiver for modifications. The letter was sent to Burwell December 29, 2015.

In the letter Governor Hutchinson said Arkansas "anticipates submitting an application" in the Spring of 2016 to amend the existing private option program under a section 1115 waiver. The administration's letter to Secretary Burwell includes a waiver application extension. 

The current incarnation of Medicaid expansion known as the private option expires at the end of 2016. The governor was required by federal officials to continue or seek changes to the waiver, or deviation from traditional Medicaid, a year in advance.

Potential changes listed under the waiver application from the Arkansas Department of Human Services reflect what the governor and a legislative Health Care Task Force agreed to in December. The Legislature is expected to convene in a special session in April to vote on Medicaid expansion.

  • Requiring premium payments for individuals in the new adult group with incomes above 100% of the federal poverty level (FPL)
  • Supporting employer-sponsored health insurance, when offered
  • Promoting work through work training referral requirement
  • Offering access to additional benefits (such as dental coverage) to enrollees who demonstrate certain healthy behaviors or comply with other program requirements 
  • Requesting additional flexibility with respect to Demonstration termination
  • Strengthening program integrity

Several of the "aspirational" waivers identified by Hutchinson during remarks to legislators in December were not the primary target of proposed changes but were mentioned.

The governor did allude to a conservative desire to require Medicaid beneficiaries be employed as part of a request requiring work training referrals: "Incentivize work by implementing work training referral requirements along with the continued discussion with the administration on the need for specific work requirements.

Hutchinson also pushed beyond a request for small premiums for the wealthiest of low-income Arkansans covered by Medicaid expansion: "Premium payments should be required for those with incomes above 100% of FPL (similar to the marketplace of 2%). Additionally other options should be considered to include some contribution for those above 50% of FPL..."

The current program known as the private option accepts federal funds from the Affordable Care Act to purchase private insurance for an expanded Medicaid population of people earning up to 138 percent of the poverty level. Each state's participation is voluntary and can be tailored within limits approved by federal officials and laws governing Medicaid's conditions of coverage. 

Several times since 2013 the Republican controlled state legislature has joined with Democrats and narrowly secured enough votes for a 3/4 requirement to adopt Medicaid expansion with modifications. Arkansas lawmakers opted to enroll Arkansans in private insurance plans rather than in traditional Medicaid. Over 250,000 people are enrolled in the plan helping to give Arkansas the biggest drop in its uninsured rate since adopting Medicaid expansion for the past two years. 

Read the application for Medicaid expansion changes in full here.