Monday, March 23, 2015

Bill would require state to clear waiting list for Medicaid developmental disabilities waiver

Posted By on Mon, Mar 23, 2015 at 1:01 PM

click to enlarge JOSH MILLER: Says waiting list must be cleared - YOUTUBE / TEAM COLEMAN
  • JOSH MILLER: Says waiting list must be cleared

Tomorrow, the House Public Health committee is expected to vote on an amended bill by Rep. Josh Miller (R-Heber Springs) that would require the state of Arkansas to clear its waiting list of families seeking a waiver to provide home and community-based care for their developmentally disabled loved ones.

HB 1749 is mostly about the Community First Choice Option (CFCO), a subject I wrote about in a cover story last fall.

A little background: Currently, Arkansas Medicaid will automatically pay for the cost of placing a developmentally disabled person in an institutional setting — such as a nursing home or a state-ran Human Development Center — but it generally will not pay for that same individual to receive care at home or in a community setting, such as a group home. (This is despite the fact that home/community-based care is typically much cheaper than institutional care.)  The state also has a waiver program that allows families to use Medicaid dollars for home/community based care, but the slots are all filled and about 3,000 families are in line to receive a waiver. Some have been waiting for seven or eight years.

The CFCO (which is a component of the Affordable Care Act) would eliminate the waiver program entirely and require all families to be offered the option of home/community based services, to be paid for entirely by federal revenue. In the long run, it would save Arkansas hundreds of millions of dollars, according to DHS estimates. Unsurprisingly, the state's nursing home industry fiercely opposes the program. Thus, while implementing the CFCO actually does not require legislation, lawmakers friendly to nursing homes and/or hostile to the Affordable Care Act have blocked the Department of Human Services from moving forward with the reform.

Now comes Miller's bill, which sets firm deadlines for clearing the waiting list. It requires DHS to present the governor with options by September 1 and the governor to decide on a plan by September 15. The waiting list must be eliminated by September 2016. The bill originally required the state to move forward with the CFCO, but the amended version merely says the waiting list has to be cleared one way or the other. However, if there's truly an alternative way to clear the list without implementing the CFCO, no one has mentioned it.

Rumor is that Gov. Asa Hutchinson is quietly supporting the bill, but I haven't heard anything official yet. I'll update this post if I hear back from the governor's office.

It's ironic that Miller is the standard bearer for the CFCO. Many of our readers probably associate the representative with his staunch opposition to the private option, despite the fact that Miller himself has received substantial medical assistance from the government (he was confined to a wheelchair after a vehicle accident as a young man). He remained opposed to the private option throughout the 2015 session, even when many of his anti-PO conservative colleagues broke ranks to join the governor in extending the private option through 2016. 

But Miller himself sees no contradiction in championing of the CFCO while opposing the private option. He's said in the past that he opposes the private option because it gives health insurance to able-bodied people, who he feels should be able to work their way into insurance coverage without government assistance. The disabled are another story, in his opinion.

"I think this should have been more of a priority and definitely should be more of a priority moving forward — to find a way to get these folks off the waiting list," he told me earlier this session.

HB 1749 would open the door to implementing the CFCO, therefore saving the state money and changing the lives of 3,000 struggling Arkansas families. Expect the nursing homes to work feverishly to defeat it. The Arkansas Health Care Association, the lobbying arm of the industry, has been plying legislators all season with food and drink at regularly scheduled receptions and lunches. Will their investment pay off? Tune in tomorrow to see for yourself: 10 a.m., House Public Health.

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