If CMS and Arkansas Agree on a Strong Evaluation Plan, I May Breathe a Bit Easier

In August I blogged about Arkansas’s waiver proposal to expand Medicaid using the so-called “private option” which actually means newly-eligible Medicaid beneficiaries will be picking plans from the new insurance marketplace established by the Affordable Care Act. The waiver proposal was approved last Friday but a number of pieces are still outstanding.

Expecting approval, the state has already been moving forward in enrolling newly-eligible persons (and doing a fantastic job I might add!). Here’s the terrific news—just like the overwhelming demand for new coverage through healthcare.gov that we have all been reading about and living the last few days, Arkansas efforts to sign up adults below 138% of the federal poverty line have been incredibly successful. A single letter sent by Arkansas Department of Human Services to 132,000 individuals (that were determined to be income eligible) generated 55,000 return letters from adults interested in coverage! An amazing success rate for a direct mail piece.

And, no surprise to us, children are already benefiting from the state expanding Medicaid to their parents – as a result of the return letters from their parents, 2,539 more kids have been enrolled in ARKids First– they don’t have to wait until January 1st. In a small state like Arkansas, which has already done a good job in reducing the number of eligible but unenrolled children, this number illustrates why children stand to gain so much in so many ways from covering their parents – since the name of the game for reducing the number of uninsured children is getting them signed up for Medicaid or CHIP coverage (as SayAhh! readers well know).

When I read the state’s waiver application I tweeted “One thumb is up, the other is holding my nose.” That was in part because the way the application characterizes Medicaid versus private coverage doesn’t add up for many reasons.  In short, the intense politicization of the Medicaid issue in Arkansas and elsewhere has resulted in some pretty fact free discussions!

For that reason, I think it will be very important to ensure that CMS and the state agree to a strong evaluation plan that is intellectually honest about the costs and benefits of expanding through this premium assistance model – as opposed to doing a traditional Medicaid expansion.

The waiver was approved so quickly (20 calendar days – a record for the current CMS).  The quick approval process is most likely reason why the state’s evaluation plan is not yet complete. CMS goes into quite a bit of detail in the terms and conditions of the waiver agreement about what it expects to see from the state in its evaluation design – a draft of which is due to CMS 60 days after waiver approval. The state is expected to “engage the public” in its evaluation design, meet “prevailing standard of scientific and academic rigor,” and look at a range of questions. After the state submits its draft, CMS will have 30 days to provide comments before the state revises the plan and ultimately seeks final approval.

A number of governors are talking about looking at the Arkansas model. Pennsylvania, Tennessee, and Georgia to name a few I have seen recently. So I for one will be keeping a close eye on this evaluation plan as it goes forward. Waivers are meant to be experiments in new policy directions – and Arkansas’s approach certainly is that. Meanwhile I will continue my “thumbs up” at the news that thousands of Arkansas families will now have affordable and comprehensive health coverage.


Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families