Last week, state officials sent a letter to the Centers for Medicare and Medicaid Services outlining a framework for Arkansas’s plan to extend health coverage to 250,000 uninsured, low-income Arkansans. However, the plan isn’t a traditional “Medicaid expansion” like we and other advocates have been talking about for months. Instead, there is interest in covering newly eligible adults through the state’s Health Insurance Exchange. The Exchange will sell private insurance plans that meet a minimum level of coverage, and it will provide subsidies to middle-income uninsured Arkansas families to help them afford coverage.

In this new proposed solution, Medicaid would pay the full private insurance premiums for eligible adults earning less than 138 percent of the Federal Poverty Level (about $15,000/year for an individual or $31,000/year for a family of four). This model of coverage is called “premium assistance” and would be in place of DHS extending its traditional Medicaid coverage.

Since private health coverage is somewhat different from Medicaid coverage, we have pulled together a list of our Top 10 Principles for covering low-income Arkansans that should apply in this new model of coverage. We are excited about the potential for new health coverage options for the half-million Arkansans who are uninsured, but we should proceed cautiously when it comes to our most vulnerable citizens – our children.

One concern in the state’s letter was a brief reference to moving children covered by the ARKids First B program into private health coverage along with their parents. (ARKids First B covers middle-income families earning between 133 and 200 percent of the federal poverty level, or up to about $46,000 for a family of four.)  About 75,000 Arkansas children have ARKids B coverage today.

While it’s always good for family members to share the same health coverage when possible, we don’t want to lose gains Arkansas has made in covering children by rushing kids into a new type of coverage overnight. We know that ARKids First works for Arkansas children and families. New coverage options may be a good idea down the road, but first we need to know that child coverage in the Exchange is affordable, with equivalent benefits and a smooth transition to new coverage. Advocates should ensure that children (and parents who have Medicaid today) can transition to new coverage with no gaps in care, and we want to make sure there is enough help from in-person assisters or “guides” to help them enroll.

We all need to be on our toes as Arkansas moves forward with its decisions about Medicaid and health coverage for all. Let’s keep the end goal in sight:  Affordable, high-quality health coverage for all Arkansans on January 1, 2014!