Arkansas Medicaid Waiver Agreement Approved

So interesting things always happen on Fridays, I have noticed. This Friday, the week before open enrollment begins, was already pretty hopping when word came that federal CMS had approved Arkansas’ Section 1115 Medicaid waiver request to provide coverage to an estimated 200,000 adults through qualified health plans offered in the Arkansas Health Connector, the state’s health insurance marketplace.

Covering these parents and other adults will help protect the health and financial security of their entire families and should lead to many more already-eligible children signing up for coverage as the state puts out the welcome mat. So we are pleased to see the state moving forward.

However we did extensive comments on some of the details that we hoped would be improved upon in the final agreement. A quick read of the final waiver agreement suggests that some of these comments were heard, some weren’t, and for many we will need to wait for follow-up documents to learn whether or not CMS took our suggestions to heart.  Important issues such as what the benefits package looks like, how the medically frail population will be identified, and the evaluation plan – are left to another day. In some cases, that day may be Monday, but it is still another day!

On the specifics though, we are disappointed to see that CMS will allow the state to include 19 and 20 year olds in the demonstration with a wraparound of the EPSDT benefit. We had argued that, in line with CMS guidance issued in March, only beneficiary groups whose benefit packages easily aligned with the Essential Health Benefits should be included because wraps are hard to do well. EPSDT clearly does not easily align with the EHBs, so that is unfortunate news.

Also, we had hoped that some more consumer focused criteria would be used for the auto-assignment process such as matching individuals with their current providers to the extent possible, but these suggestions were not adopted, either. Of course, there is some merit for consumers in the state’s approach, which seeks to ensure that multiple plans stay in the market to promote consumer choice.

For some good news, beneficiaries will have a choice of at least one QHP that contracts with a community health center in their area.

And in a fascinating twist, CMS actually waived the regulatory standard for cost-effectiveness in premium assistance programs that I blogged about earlier this year. This is a complex issue that I am still digesting, and I will say more about this in a future blog post!

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.