Governor says focus will be on vulnerable populations
President Joe Biden's administration on Tuesday cleared the way for Arkansas' Medicaid expansion program to proceed with implementing a rural health care initiative targeting certain at-risk populations, Gov. Asa Hutchinson announced Tuesday.
The U.S. Centers for Medicare and Medicaid Services approved an amendment to the state's waiver for Arkansas' Medicaid expansion program to include innovative services called Life360HOMES, the Republican governor said at a news conference in the governor's conference room.
The state's Medicaid expansion program is now called ARHOME -- the Arkansas Health and Opportunity for Me -- and provides health care coverage to about 340,000 low-income Arkansans.
The federal government pays for 90% of the cost of the Medicaid expansion program and the state covers the rest of the tab. In fiscal 2023 that started July 1, the state Department of Human Services forecasts spending $2.67 billion for ARHOME with the state share of about $267 million, department spokesman Gavin Lesnick said.
ARHOME started Jan. 1 and ends Dec. 31, 2026, under the waiver for the program granted by the U.S. Centers for Medicare and Medicaid Centers to the Hutchinson administration in December.
Hutchinson said the Legislature in 2021 authorized ARHOME with a focus on improving health outcomes of beneficiaries of the program by holding insurance carriers accountable for meeting health improvement targets.
He said the amendment to the waiver for ARHOME approved by the Biden administration Tuesday focuses on improved maternal care, mental health services and addiction services. The amendment also will provide more support for people coming out of foster care and prison, those involved with the juvenile justice system, as well as young adult veterans who are at high risk of homelessness, addiction or in need of mental health services, he said.
"These are very vulnerable populations and, if we can improve their health outcomes and their access to addiction treatment or ... mental health services ... or some other health need, then we are going to not only improve their life outcome, but we are going to reduce the cost of health care that is associated with the at-risk population," Hutchinson said.
Arkansas has one of the highest maternal mortality and infant mortality rates in the nation, "so we've got to tackle these difficult problems that we have had for decades and decades and decades," he said.
This initiative will focus on providing services for women with high-risk pregnancies during pregnancy and for up to 24 months after the baby is born, Hutchinson said.
There were about 12,500 women on Arkansas Medicaid diagnosed with high-risk pregnancies in 2021, he said.
Sen. Missy Irvin, R-Mountain View, said "we want to make sure that we give that mother and that baby the best chance at a healthy and a successful life as possible."
She said this initiative is aimed at bringing all services to women in a more focused way to achieve a better outcome for the women and their children.
Hutchinson said the federal government will pay 80% of the cost for this initiative and the state will pay for the other 20%, and the federal government will chip in $13.6 million a year for the initiative and the state will contribute $3.2 million a year in general revenue.
"I expect that this is going to reduce health care costs," he said.
According to the governor's office, different types of Arkansas Medicaid-enrolled hospitals can serve as Life360 providers.
For the Maternal Life360 service, providers must be a birthing hospital that will provide or contract with an evidence-based home-visiting partner to provide home-visiting services to women with high-risk pregnancies for up to two years after a baby's birth, the governor's office said in a news release.
Clients are eligible if they are enrolled in ARHOME or another Medicaid program, have a high-risk pregnancy diagnosis and are pregnant at the time of enrollment, live in the Life360 service area, and are not already receiving home-visiting services. Clients can be referred for diagnosis and Life360 services by OB/GYNs, qualified health plans, or community networks like homeless shelters and churches.
A Rural Life360 provider must be a general or critical access hospital with 50 or fewer beds located in a rural area of the state, according to the governor's office.
These Life360s will directly provide community screens for health-related social needs and intensive care coordination for enrolled clients. Each approved Rural Life360 will also receive funding to operate an Acute Crisis Unit that's available 24/7.
Clients are eligible for care coordination services if they are enrolled in ARHOME, have a diagnosis of serious mental illness, and live in the Life360 service area, according to the governor's office. Clients who are enrolled in a Provider-Led Arkansas Shared Savings Entity (PASSE) will continue to receive care coordination services through their PASSE, rather than a Life360 HOME.
Success Life360 providers must be an acute care hospital in Arkansas. Each of these providers will contract with community organizations with experience working with young adults most at risk of long-term poverty to build life skills, according to the governor's office.
Clients are eligible if they are enrolled in ARHOME, live in the Life360 service area, and meet one of the following four eligibility categories:
• Formerly in foster care, ages 19-27
• Formerly incarcerated, ages 19-24
• Formerly in Division of Youth Services custody, ages 19-24
• Veterans, ages 19-30
Clients who are enrolled in a PASSE will continue to receive care coordination services through their PASSE, rather than a Life360 HOME, the governor's office said. The Department of Human Services is ready to accept letters of intent from potential Life360 HOMEs.
States have the option of authorizing Medicare expansion programs under the federal Patient Protection and Affordable Care Act signed by then-President Barack Obama in 2010.
The federal law is often called Obamacare. Arkansas has obtained waivers under federal law for its three versions of Medicaid expansion.
In 2013, the state's Medicaid expansion program was initially authorized by the Republican-controlled Legislature and then-Democratic Gov. Mike Beebe. The program initially was called the private option.
Under Hutchinson, the private option was replaced by Arkansas Works in 2016 and Arkansas Works expired Dec. 31. That program's work requirement was not enforced after a federal judge ruled in March 2019 that federal law did not allow then-President Trump's administration to authorize that requirement in Arkansas.
A three-fourths vote of the 100-member House of Representatives and the 35-member Senate is required each year to grant spending authority for the Department of Human Services' Division of Medical Services, which includes the Medicaid expansion program, each fiscal year.
At times, it's been difficult for supporters of the program to get the required 75 votes in the House and the required 27 votes in the Senate for spending authority for the Division of Medical Services because of disagreement among Republican lawmakers over the Medicaid expansion program.
In the fiscal session in March, the House of Representatives voted 91-3 to approve the Department of Human Services' Division of Medical Services appropriation for fiscal 2023, and the Senate voted 32-0 to approve the appropriation. Act 213 of 2022 grants $9.05 billion in spending authority for grant payments of the Division of Medical Services.
At the start of September, there were 1,121,689 clients enrolled in Medicaid, including 339,297 served through ARHOME, Lesnick said.
"As of October 4, 2022, 347,593 clients have had their coverage extended due to the Public Health Emergency and are at-risk of losing their coverage [and] 117,674 of those are covered through ARHOME," he said. "We do not know how many of those who have been extended will actually be ineligible for Medicaid, which is why we continue to encourage everyone to update their information."
The federal Public Health Emergency has been extended through Jan. 11, Lesnick said.
Asked whether Arkansas' current Medicaid expansion program is politically safe, Hutchinson said Tuesday that "even though there is going to be a change in administration, this has legislative support."
The governor said the Medicaid expansion program has broad legislative support and he hopes the program will continue without any contention.
House Public Health, Welfare and Labor Committee Chairman Jack Ladyman, R-Jonesboro, said he expects legislative support for the Medicaid expansion program to continue in the 2023 regular session.
"If we focus on our most difficult areas, we can improve," he said.
"We may have to take small steps at first, but this is a big deal and I think it will help us tremendously moving forward," Ladyman said.
In Tuesday's general election, voters will elect Hutchinson's successor as governor.
Last month, Republican gubernatorial nominee Sarah Huckabee Sanders said the state's overall Medicaid program makes up nearly a third of the state's budget and "we can always look for ways to improve outcomes and reduce costs.
"I will work with the Legislature to resubmit a work requirement to the federal government so that we are encouraging people who can work to get a job and not be trapped in a lifetime of government dependency," she said.
The work requirement approved by the Trump administration for Arkansas' program resulted in more than 18,000 people losing coverage before it was struck down by a federal judge in 2019.
Democratic gubernatorial nominee Chris Jones has said he supports the Medicaid expansion program and wants to make it accessible to as many Arkansans as possible, while Libertarian candidate Ricky Dale Harrington, Jr. has said he is not going to trash the Medicaid expansion program.