Tuesday, September 13, 2016

Governor: Use tobacco settlement money to reduce disability waiting list

Posted By on Tue, Sep 13, 2016 at 12:54 PM

click to enlarge SOME PROGRESS: Asa Hutchinson hopes to reduce the DD waitlist significantly (file photo). - BRIAN CHILSON
  • BRIAN CHILSON
  • SOME PROGRESS: Asa Hutchinson hopes to reduce the DD waitlist significantly (file photo).

Governor Hutchinson appeared this morning before the Arkansas Tobacco Settlement Commission to announce he will ask the legislature to allocate $8.5 million in tobacco settlement money to help reduce the state's developmental disability waiver waiting list.

The 3,000-person waiting list is composed of families with severely disabled children (including adult children) who are seeking home- or community-based services, such as home health aides. Some have been waiting for eight or nine years to receive such services. The $8.5 million should reduce the list substantially — by 500 to 900 people, the governor said today. But it will not clear it.

The $8.5 million in question previously funded AR Health Networks, a small health insurance program that was essentially rendered obsolete when Arkansas began making subsidized insurance available to almost all low-income citizens via Medicaid expansion. If approved by the legislature, the money will pull in additional federal funds at a 70-30 match, meaning the Department of Human Services will have a total of around $29 million to apply to reducing the waiting list. (Just how many families that money pays for depends on the level of care they require, as determined by DHS.) Hutchinson said the idea to fund the waiting list reduction from tobacco settlement funds came from DHS Director Cindy Gillespie.

This morning, Hutchinson said the move won't require approval from the tobacco settlement commission, but he wanted to notify the members of his plans and seek their blessing. Susan Hanrahan, the panel's chair, said she supported the move, and no commissioner voiced opposition.

Any progress on reducing the list is good news. The frustrating thing is that there's another, better source of funds available to address the issue — a federal program called the Community First Choice Option, which is an optional incentive available for states that was created by the Affordable Care Act. Hutchinson said this morning that CFCO is entirely "off the table" at this point, because it creates an "entitlement" and a "long-term commitment" for the state. States have been wary to implement CFCO, he said. (It's true that not many states have moved in that direction, but some have — notably, Texas.)

CFCO allows states to access an enhanced federal match rate if they agree to move away from institutional care settings (such as human development centers and nursing homes) and towards home/community based services in general. But CFCO ran into opposition from legislators who mistrusted its association with "Obamacare," as well as nursing homes looking to protect their turf and human development center advocates concerned about the institutions' future closure. The issue also scrambled partisan lines in unusual ways in 2015, when hard-right Rep. Josh Miller (a vocal foe of Medicaid expansion and Obamacare) began championing the adoption of CFCO. Miller, who is himself physically disabled, introduced a bill that would have required the waiting list to be cleared rapidly, and he brought some fellow conservative members along with him. But in the end, Hutchinson opposed Miller's bill and it died in committee.

Earlier this year, Hutchinson pledged to reduce the waiting list by half within three years. He planned to fund that reduction by tying it to his plan to implement managed care in portions of the state's Medicaid program. After much legislative wrangling this spring, the managed care discussion subsided, but it may well reemerge in the 2017 session. The governor declined to answer a question about managed care this morning.

One reporter today asked Hutchinson what he had to say to the thousands of people who would remain on the list if his proposal wins legislative approval. He replied, "this is progress, this is hope. This shows the seriousness of the state in addressing the waiting list, and once you start whittling down that waiting list, you're going to move up on it much quicker."

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