{"id":22998,"date":"2021-12-31T12:01:18","date_gmt":"2021-12-31T18:01:18","guid":{"rendered":"https:\/\/arknews.org\/?p=22998"},"modified":"2021-12-31T12:48:11","modified_gmt":"2021-12-31T18:48:11","slug":"biden-administration-says-premiums-for-arkansas-medicaid-expansion-must-end-in-one-year","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2021\/12\/31\/biden-administration-says-premiums-for-arkansas-medicaid-expansion-must-end-in-one-year\/","title":{"rendered":"Biden administration says premiums for Arkansas Medicaid expansion must end in one year"},"content":{"rendered":"

In June 2018, when Arkansas became the first state in the nation to implement work requirements for certain Medicaid beneficiaries, Governor Hutchinson was triumphant.<\/span><\/p>\n

\u201cWe\u2019ve wanted to establish a work requirement \u2026 for a long time,\u201d <\/span>he said at the time<\/span><\/a>. The Obama administration had refused to authorize work requirements, but the Trump administration gave the green light. \u201cWith this development, Arkansas has become a national leader in rethinking the delivery of public assistance,\u201d the governor boasted.<\/span><\/p>\n

Three and a half years later, the work requirements are gone. The state did not even ask to continue the policy after the Biden administration <\/span>signaled<\/span><\/a> early in 2021 that it would no longer allow Medicaid work requirements. The Biden administration <\/span>officially revoked <\/span><\/a>the state\u2019s authorization in March; by that point, the policy had already been blocked for two years by a federal judge.<\/span><\/p>\n

Last week, the Biden administration established another red line. On Dec. 21, the federal government approved a proposal from Arkansas officials to continue the state\u2019s unique version of the Medicaid expansion program, but<\/span> the feds rejected Arkansas\u2019s request to continue imposing monthly premiums on certain beneficiaries. The premiums will be allowed to continue for one more year before ending on December 31, 2022.<\/span><\/p>\n

The Medicaid expansion, authorized by the federal Affordable Care Act, covers adults aged 19-64 who make less than 138% of the federal poverty level (an annual income of $17,774 for an individual or $36,570 for a family of four). Ideological opposition to Obamacare has led to fierce debates in red states over whether to expand Medicaid, and a dozen states still have not done so. Some Republican governors, like Hutchinson, have been willing to take the federal money for coverage expansion \u2014 but have sought to bend the program in various ways, including imposing requirements on beneficiaries that critics allege create barriers to coverage and reduce the number of people enrolled.<\/span><\/p>\n

Federal law allows states to experiment with new policies that deviate from Medicaid rules under agreements known as waivers, but such programs require federal approval.<\/span> In an <\/span>executive order<\/span><\/a> last January, the Biden administration announced it would review Medicaid waiver policies \u201cthat may reduce coverage under or otherwise undermine Medicaid or the ACA.\u201d<\/span><\/p>\n

Work requirements were the first shoe to drop. Now, the Biden administration has made clear it will not allow premiums to be imposed on beneficiaries in the Medicaid expansion population, nixing proposals to continue premiums from both Arkansas and Montana on Dec. 21. In both cases, the Biden administration gave a one-year off ramp before premiums will end.<\/span><\/p>\n

Three other states currently have waivers for Medicaid expansion premiums,<\/span> according to tracking by the Kaiser Family Foundation<\/span><\/a>. <\/span>(Another such waiver is pending, and another has been currently set aside by a court ruling.) Presumably, the Biden administration will not renew such provisions or allow new requests for premiums from other states.<\/span><\/p>\n

The novel version of the Medicaid expansion program in Arkansas, first enacted in 2014, uses Medicaid funds to purchase private health insurance plans on the Arkansas Health Insurance Marketplace \u2014 the regulated marketplace created by the ACA \u2014 to cover most beneficiaries.<\/span> Once nicknamed the \u201cprivate option\u201d and now known as \u201cArkansas Works,\u201d it has been implemented under a series of waiver agreements with the federal government.<\/span><\/p>\n

The \u201cArkansas Works\u201d waiver expires at the end of this year. Arkansas\u2019s request for a new waiver, submitted last summer, renamed the program ARHOME and outlined new changes and policy initiatives.<\/span><\/p>\n

Despite the rejection of the state\u2019s request on premiums, Governor Hutchinson described the feds\u2019 overall approval of ARHOME as \u201cgood news\u201d in a press conference on Dec. 21. \u201cThis will allow 300,000 low-income Arkansans to continue to receive health care,\u201d Hutchinson said.<\/span><\/p>\n

The governor said the Biden administration\u2019s decision against allowing premiums in ARHOME was \u201cnot unexpected,\u201d despite the state\u2019s efforts to convince federal regulators otherwise. \u201cWe continue to believe it is important for nonelderly, nondisabled adults to contribute to the cost of their coverage,\u201d Hutchinson said in an email this week.<\/span><\/p>\n

The governor noted that beneficiaries still may incur some costs even after premiums are phased out. Small co-pays are allowed under Medicaid rules, with certain limitations. (Premiums are monthly payments made at a set rate, whereas co-pays are assessed when a medical service is actually used.)<\/span><\/p>\n

Arkansas Works currently charges co-pays to most beneficiaries who make more than the federal poverty line. The state\u2019s ARHOME waiver request proposed allowing co-pays to be charged to some beneficiaries with lower incomes (down to 21% of the federal poverty level) and raising the caps on the total quarterly amounts that can be charged to those at higher incomes, among other changes. State officials hope to implement the updated co-pays \u2014 which will follow normal Medicaid rules \u2014 this year, pending approval from the state legislature and the Biden administration.\u00a0<\/span><\/p>\n

Arkansas had received permission for premiums under its previous waiver agreement, which was approved by the Obama administration. (After Trump took office, the waiver was amended to include work requirements, approved in 2018.) But the Centers for Medicare and Medicaid Services (CMS), the federal agency overseeing Medicaid, \u201chas since determined that premiums can present a barrier to coverage,\u201d according to a letter CMS Administrator Chiquita Brooks-LaSure sent to the state last week.<\/span><\/p>\n

Premiums for Medicaid expansion beneficiaries \u201care not likely to promote the objectives of Medicaid,\u201d Brooks-LaSure wrote in the letter, which accompanied the federal approval for ARHOME.<\/span><\/p>\n

Joan Alker, the executive director of Georgetown University\u2019s Center for Children and Families, said that CMS made the right decision.<\/span><\/p>\n

\u201cFor low-income populations, it\u2019s very clear that premiums reduce participation,\u201d Alker said. \u201cThere\u2019s lots of research to back this up: When premiums are imposed, enrollment goes down. In our system having insurance is the price of admission, so we\u2019re just kicking people out of the system.\u201d<\/span><\/p>\n

Currently, the state imposes $13 per month premiums on most beneficiaries who make more than the federal poverty line ($12,880 for an individual or $26,500 for a family of four). Beneficiaries do not lose coverage for failure to pay, but incur a debt to the state, which can be withheld from state tax refunds.<\/span><\/p>\n

Alker said premiums can still be a barrier to coverage even if the state doesn\u2019t kick people off Medicaid for failing to pay. People might be reluctant to sign up in the first place or worry about accruing debt for bills they can\u2019t afford.<\/span><\/p>\n

\u201cAny premium is acting as a deterrent to enrollment,\u201d she said. \u201cIf people think they have to pay a premium and they don\u2019t have the money, they probably haven\u2019t read the fine print.\u201d<\/span><\/p>\n

The waiver proposal for ARHOME that the state submitted earlier this year described a plan to increase premiums in 2022 to between $22 and $27 for those above the poverty line, depending on income. Failure to pay would still not have led to a loss in coverage, but would have incurred a debt to the insurance companies rather than the state.<\/span><\/p>\n

CMS will allow the state to continue charging premiums to beneficiaries above the poverty line for one more year to allow \u201ca planned phase-out of the policy,\u201d giving Arkansas time to communicate the change to beneficiaries and make necessary operational changes. State officials said the current $13 per month premiums will continue through 2022. (From this point forward, any debt for unpaid premiums will be up to the insurance companies to collect, rather than the state. However, both the old waiver and the new waiver prohibit reporting the debt to credit bureaus, referring the debt to collection agencies, or taking legal action to collect the debt.)\u00a0<\/span><\/p>\n

Medicaid waivers like ARHOME are intended to allow states to experiment with new initiatives to further the objectives of the Medicaid program. States are supposed to evaluate these demonstrations or pilot programs to test a hypothesis about the benefits of policies like premiums or work requirements. In her letter to the state, Brooks-LaSure wrote that the decision to deny authorization for premiums was informed by research in other states with similar waiver programs, which showed that the premiums \u201cresulted in shorter enrollment spells, and were associated with lower initial enrollment rates and increased obstacles to accessing care in several states.\u201d<\/span><\/p>\n

In Arkansas, Brooks-LaSure wrote, <\/span>the state\u2019s evaluation of Arkansas Works<\/span><\/a> likewise indicated that \u201cbeneficiaries had shorter, but more frequent gaps in coverage.\u201d<\/span><\/p>\n

Brooks-LaSure added that \u201cpremium requirements can exacerbate health disparities,\u201d pointing to research from several states that showed the barriers to enrollment created by premiums were worse for Black beneficiaries and lower-income beneficiaries.<\/span><\/p>\n

The ARHOME agreement with the feds will go into effect on January 1 and run through 2026. It will continue to use private insurance plans to cover most beneficiaries. In addition to the changes to co-pays, the state\u2019s proposal outlines a number of other new features, including: incentives to encourage wellness and \u201ceconomic independence\u201d in the form of small rewards offered by the private plans; moving beneficiaries to traditional Medicaid if they are deemed \u201cinactive,\u201d meaning they don\u2019t use their private health plan at all; a reduction in retroactive Medicaid coverage for new enrollees from 90 days to 30 days; efforts to hold the insurance companies accountable in terms of health outcomes, as well as mechanisms to curb cost growth for the insurance plans;<\/span> and new programs for rural health, maternal and infant health, behavioral health and certain at-risk populations.<\/span> Some of these new initiatives are still in development and will require additional federal approval.<\/span><\/p>\n

Two days after the feds rejected premiums in Arkansas and Montana, the Biden administration rescinded the authority for work requirements (as well as premiums) for a Medicaid waiver in Georgia that had been approved by the Trump administration. Georgia was the last state that still had waiver authority for Medicaid work requirements, though the state had not yet implemented the policy. The Biden administration has now formally revoked approval in ten states, <\/span>according to the Kaiser Family Foundation<\/span><\/a>, with other states withdrawing after receiving approval.\u00a0<\/span><\/p>\n

The Arkansas work requirements have been suspended since a federal judge halted the policy in March 2019. The program required certain beneficiaries to report their hours worked each month to the state Department of Human Services; if they were not working, they could instead report participation in job training programs, job searches or certain approved volunteer activities. If beneficiaries failed to comply, they would be kicked out of the program and lose coverage. Over the course of 5 months in 2018 and 2019, more than 18,000 Arkansans lost their health insurance due to the policy before it was halted by the federal courts.<\/span><\/p>\n

State officials aren\u2019t giving up on work requirements in the future, even if the policy is dormant for now: In the waiver proposal for ARHOME, Arkansas officials stated their intent to seek an amendment to the waiver \u201cif federal law or regulations permit the use of a work and community engagement requirement as a condition of eligibility in the future.\u201d<\/span><\/p>\n

The only trace of the policy that remains in the current incarnation of ARHOME: Beneficiaries may earn small rewards from the private insurance companies for participating in health improvement or work-related activities. The insurance companies are required to offer four wellness-related incentives and one for \u201ceconomic independence.\u201d\u00a0<\/span><\/p>\n

\u201cThe rewards may be redeemed in the form of a gift card, which beneficiaries will have several options to choose from,\u201d said<\/span> Max Greenwood, vice president of government and media affairs for Arkansas Blue Cross Blue Shield, one of the insurance companies that provides coverage to Medicaid expansion beneficiaries. \u201cBeneficiaries can earn rewards ranging from $15 to $200, and also may be eligible for multiple rewards in any given benefit year.\u201d<\/span>\u00a0<\/span><\/p>\n

This story is courtesy of <\/span><\/i>the Arkansas Nonprofit News Network<\/span><\/i><\/a>, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

In June 2018, when Arkansas became the first state in the nation to implement work requirements for certain Medicaid beneficiaries, Governor Hutchinson was triumphant. \u201cWe\u2019ve wanted to establish a work requirement \u2026 for a long time,\u201d he said at the time. The Obama administration had refused to authorize work requirements, but the Trump administration gave […]<\/p>\n","protected":false},"author":6,"featured_media":22999,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[329,113,17,115,118,144,330],"class_list":["post-22998","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","tag-arhome","tag-arkansas-works","tag-asa-hutchinson","tag-medicaid","tag-medicaid-expansion","tag-premiums","tag-work-requirements"],"yoast_head":"\nBiden administration says premiums for Arkansas Medicaid expansion must end in one year - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2021\/12\/31\/biden-administration-says-premiums-for-arkansas-medicaid-expansion-must-end-in-one-year\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Biden administration says premiums for Arkansas Medicaid expansion must end in one year - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"In June 2018, when Arkansas became the first state in the nation to implement work requirements for certain Medicaid beneficiaries, Governor Hutchinson was triumphant. \u201cWe\u2019ve wanted to establish a work requirement \u2026 for a long time,\u201d he said at the time. 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Politico wrote that his \u201creporting for the Arkansas Times on his state\u2019s unusual Medicaid expansion approach set the tone of a national conversation.\" He was named to the Washington Post's 2015 list of best state political reporters. 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