Arkansas Surgeon General Dishes On Medicaid Expansion To County Judges

Feb 11, 2016

Arkansas Surgeon General Gregory Bledsoe speaking at the winter meeting of the County Judges Association of Arkansas.
Credit Association of Arkansas Counties

The surgeon general of Arkansas made the case to the County Judges Association of Arkansas at its winter meeting that continuing Medicaid expansion will help free up state funds for other programs, such as the governor's highway plan.

The president of the association, Judge David Hudson of Sebastian County, said the group may take a position before the special session on Medicaid expansion expected in April. 

“What we’re struggling with maybe somewhat is there is the need to continue this program and it’s going to take 75 percent of the legislature to continue the program. I think that our senators and our representatives like to know what the county judges think if we choose to take a formal position in this matter.”

Dr. Greg Bledsoe addressed a roomful of county judges at the Wyndham Riverfront hotel in North Little Rock on Thursday.

"I have very close friends, people I admire on both sides of that issue," said Bledsoe prefacing two arguments.

One: "When Medicaid expansion was initiated a few years ago as the private option, the thing that's caught my attention, is a lot of the support structures for our hospitals, our healthcare systems and our patients that had been in place were dismantled because of the extra money that was coming in. That wouldn't be a sudden thing, that would take a lot of time to rebuild. To get back to where we were is not an easy fix."

Two: "For better or for worse, whatever you're politics, what's happened with Medicaid expansion is it's matched 9 to 1. Even at the worse case scenario the federal government is going to pay for 90 percent of the spending for the Medicaid expansion as opposed to 70 percent for traditional Medicaid. That's a 20 percent difference that makes a big deal. What it allows the state to do, is allows the state to take the extra money from the federal government and to move some of the costs to the federal government. Obviously that's controversial in a lot of ways."

After his remarks to the judges association Bledsoe talked with KUAR about his trip to Washington D.C. earlier this month with Governor Asa Hutchinson, Senate President Jonathan Dismang, House Speaker Jeremy Gillam, state Medicaid Director Dawn Stehle, and adviser John Martin. The Arkansas group met with US Department of Health and Human Services Secretary Sylvia Burwell to the lay groundwork for negotiations on new restrictions for coverage. 

Changes to state-level implementation of Medicaid expansion require federal approval. Arkansas's current incarnation known as the private option provides private insurance to residents earning up to 138 percent of the federal poverty level rather than using the government insurance program, Medicaid. It covers about 250,000 Arkansans.

Hutchinson is seeking a waiver to incentivize work, add small premiums for some, require beneficiaries to be on employer-based coverage when possible, and make changes to program integrity at the state Department of Human Services. He calls it Arkansas Works. A special legislative session on the proposal is expected in early April. 

Bledsoe said federal officials are being fair partners within the expectations set under the Democratic presidential administration.

“Obviously there are going to be things that we would want that aren’t going to be given to us. But I do believe that they’re going to do everything they can within the framework that they’re allowed to flex on to give us that flexibility,” he said.

Bledsoe also elaborated on the governor’s as yet to be specifically defined work training referral requirement for coverage. Bledsoe said the Governor Hutchinson asked not only that beneficiaries had to receive a referral for skills training in exchange for coverage but would have to adequately attend any training program.

“The federal government has drawn a line in the sand that you can’t require a job to get Medicaid. The governor has said, if we can’t require a job then we’d like to at least require a referral and some way of tracking that people are going to these referrals. Don’t just check a box, actually go and get the training,” said Surgeon General Bledsoe.

The governor has said he’ll reveal more details of his meeting when he speaks with legislative health care task force February 17.