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Thursday, February 21, 2013

Gov. Mike Beebe asking feds for flexibility on Medcaid expansion

Posted By on Thu, Feb 21, 2013 at 5:47 PM

Gov. Mike Beebe is set to meet tomorrow afternoon with U.S. Secretary of Health and Human Services Kathleen Sebelius and other HHS officials to discuss possible flexibility regarding the state’s Medicaid expansion.

Matt DeCample, the governor’s spokesman, said that Beebe will focus on requesting whether some people set to go in to the Medicaid program could instead be routed into the health-insurance exchange, where they would buy government-subsidized private health insurance. Beebe’s hope is that such a plan would still expand coverage but represent smaller growth in the state Medicaid program.

There are two different ways that this could work. One is the idea of “partial expansion,” which has been pushed by many Republican lawmakers as a possible compromise. Under the Affordable Care Act, Medicaid is supposed to expand to cover all people making up to 138 percent of the federal poverty level (around $15,000 for an individual). Partial expansion would set the line lower, perhaps to 100 percent of FPL, and then send the remaining folks between 100 and 138 to the exchange, where they would be subsidized to buy private insurance (premiums would be around $20 to $30 per month for this group).

Thus far, the feds have said no to partial expansion. The law requires expanding all the way up to 138 FPL to get the enhanced federal match rates as part of the ACA (100 percent match for the first three years), and the administration has consistently said it’s all or nothing. However, Beebe plans to ask Sebelius if the feds will bend on this point.

The other possibility, floated by Beebe and which the feds have been more open to, is allowing folks in the 100-138 FPL group to have the choice of either going to Medicaid or paying a subsidized premium on the exchange. DeCample said that Beebe will pursue both ideas with Sebelius.

DeCample also said that the governor plans to ask about flexibility even beyond the 100-138 group. “We’ve been asked to inquire whether we can go past 100,” he said, noting that under terms negotiated by the latest GOP governor to come out in favor of expansion, Florida Gov. Rick Scott, Florida may be able to cover some Medicaid recipients under 100 percent of FPL through private managed care. Florida’s deal is not really in an analogous situation because Arkansas does not have a managed care program, but DeCample nonetheless thought it was a hopeful sign that the feds may be open to private-coverage options for a broader group. “We’re going to ask about moving the 100-138 group to the exchange and if that becomes a possibility, we’re going to take the ask one step further,” he said.

As for Scott’s decision yesterday, DeCample said, “he's someone who had come out before and said he'd be the last one. It shows just how good of a deal this can be.”

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