The Health Care Dance Continues: Arkansas Takes One Step Forward and Two Steps Back

Today, lawmakers voted to make more changes to Arkansas Works, the state’s Medicaid expansion program that provides coverage for over 300,000 Arkansans, during a special session.

With few consumer protections and details on the implementation of these policy changes, this legislation gives the state legislative approval to make four changes to Arkansas Works: lower the income eligibility, implement a work requirement, end mandatory enrollment in subsidized employer-sponsored plans, and give the state responsibility to use its system (rather than the federal portal) to determine eligibility.

If implemented in January 2018 as planned, we know that these changes will immediately result in 60,000 people losing coverage in Arkansas Works and impose new barriers to staying covered, which we detailed in an earlier post. Supporters of the bill argue that these changes will save the state money, despite anticipating it will also cause premiums to increase by about 2 percent.

Although state lawmakers have approved the changes, the Department of Human Services (DHS) must now seek federal approval. In the past, federal regulations have prevented the state from imposing restrictions like a work requirement as a condition of eligibility for Medicaid. However, with the promise of increased flexibility under the new administration, these federal guardrails are much more flexible and lenient when it comes to enforcing consumer protections.

Since the legislation left out details like the development of an outreach plan or when enrollees will be notified of the changes, state agency officials have stated more specifics will be determined as they develop the rules and seek federal approval. While we have an overall concern that the policy changes will result in many Arkansans losing coverage, the following polices could help make the transition better for the people enrolled:

  1. DHS and insurance carriers should auto-enroll beneficiaries who are no longer eligible for Arkansas Work in a QHP (marketplace plan) unless they opt out. Enrollees should be informed of premiums and new cost-sharing requirements, like higher co-pays and deductibles.
  2. DHS should cover any increased premium and cost-sharing for a six-month transition period for enrollees who become ineligible, or offer this as an incentive available for meeting certain healthy behavior requirements.
  3. DHS or the insurance carriers should develop an outreach plan that includes plain-language notices (at an appropriate reading level) informing enrollees about changes to their coverage at least 90 days prior to implementing the policy change.
  4. The state should work with and refer enrollees to navigators and community organizations to educate enrollees about their coverage options and assist them with enrollment.
  5. DHS should evaluate the impact of these policy changes and collect data on the number of people who became ineligible for Arkansas Works; the number of former enrollees who applied for a QHP or other coverage; the number of enrollees who successfully paid a premium and enrolled in coverage; and the number of former enrollees who did not sign up for coverage. This data should be collected and reported quarterly.

These recommended polices will at the very least create public transparency so we are aware of the effects of these changes on families. They will also ensure people are given adequate help to successfully transition to other coverage options. With many working families now at risk of losing their coverage and facing the burden of more out of pocket costs, Arkansas has taken a risky step in the wrong direction, especially with the uncertain future of health care at the federal level.

You can find more information about the changes to Arkansas Works and the resulting coverage barriers here. Other media outlets have also reported on the special session.