After lawmakers and a prison official expressed concerns, a legislative committee Monday delayed a vote on a proposed rule change that would limit retroactive health insurance for some receiving government assistance.
Under the proposed Arkansas Works waiver change, retroactive coverage for a new enrollee would be limited to the first day of the month when the Medicaid application was submitted. Currently, enrollees receive coverage for up to 90 days of medical expenses incurred before the date of the application.
During a joint House and Senate Public Health, Welfare and Labor committee meeting Monday, no lawmaker spoke in favor of the proposed change.
Rep. Jeff Wardlaw, R-Hermitage, said the rule would put people in a bind who are injured at the end of a month, qualify for Arkansas Works, but aren't able to get enrolled before the first of the following month.
"That's the whole reason we've had retroactive coverage," he said. "That's the whole reason the hospitals are standing in the back of the room screaming, 'Kill the bill.' So explain to me how you fix that and if you can't fix that, figure out how to take this rule back and rework it."
However, officials from Department of Human Services said lawmakers had required them to propose the rule in the first place. A law passed during the second special session of 2016 mandates that the department seek a federal "waiver to eliminate retroactive eligibility for an eligible individual."
The change would save the Department of Human Services about $371,000 next fiscal year, according to a financial impact statement.
The provision was a part of Act 2, which created Arkansas Works.
"Yes, this was part of our request and done to continue our efforts to try to align the Arkansas Works benefit structure with the benefit structure that is typically available in the employer-sponsored and commercial insurance markets, which do not offer retroactive coverage," wrote Amy Webb, a spokesman for the Department of Human Services, when asked if the department had requested the provision be a part of the bill.
After about 30 minutes of discussion on the rule change, Sen. Missy Irvin, R-M̶o̶u̶n̶t̶a̶i̶n̶ ̶H̶o̶m̶e Mountain View*, made a motion to hold the decision for a meeting next month. The committee approved her motion in a voice vote.
"Your financial savings is not from premiums you would have to pay," Irvin told the department. "It's from not paying the providers for doing work that they actually did."
B̶o̶t̶h̶ ̶I̶r̶v̶i̶n̶ ̶a̶n̶d* Wardlaw voted for Act 2, which contained the provision.
Later Monday, Solomon Graves, spokesman for the Arkansas Department of Correction, described the rule change as a "cost-shift" for state prisons.
"Current rules provide for retroactive Medicaid coverage for an inmate once they are admitted to a hospital," he said in a statement. "Eliminating this coverage option would potentially increase our medical contract costs by approximately $7 [million] annually."
Wendy Kelley, director of the department, met with Cindy Gillespie, director of the Department of Human Services, and Gov. Asa Hutchinson before Monday's legislative committee meeting to discuss the impact of the change, Graves said.
"Director Kelley raised some important concerns in terms of continuing coverage of the prison population to the governor," said J.R. Davis, the governor's spokesman. "The governor directed Director Gillespie with DHS and Director Kelley to work together, and he's confident that we can find a change so there's no adverse impact to the Arkansas Department of Correction."
During Monday's legislative meeting, Kelley Linck, chief of legislative and governmental affairs for the Department of Human Services, said the officials planned to huddle again later Monday for a "war room" meeting to discuss the cost for the Correction Department.
"We cannot let that happen," Linck said of the cost shift.
Arkansas Works is Hutchinson's take on the state's Medicaid expansion under the Patient Protection and Affordable Care Act. Like the private option created under then-Gov. Mike Beebe, the state is buying private health insurance for poor residents using funds.
However, Hutchinson backed changes including charging premiums of about $19 a month to enrollees with incomes above the poverty level, providing coverage to some enrollees through subsidized employer plans and offering an extra benefit, such as dental coverage, as an incentive for enrollees to pay premiums and receive annual wellness exams.
Under changes set to take effect Jan. 1, an estimated 60,000 people would be moved off the Arkansas Works Medicaid program. Most of those who would lose Medicaid coverage as a result are expected to qualify for subsidies to help them buy private insurance on the state's health insurance exchange.
Metro on 08/15/2017
*CORRECTION: Sen. Missy Irvin, R-Mountain View, voted against Act 2 of the special session of 2016. That act created the Arkansas Works Medicaid-expansion program, and it included a requirement that the state Department of Human Services seek a federal “waiver to eliminate retroactive eligibility for an eligible individual.” An earlier version of this story misstated how she voted. The article also misidentified her city of residence.