Attorney general Leslie Rutledge confirms that feds will not allow state to cap enrollment in Medicaid expansion | Arkansas Blog

Monday, August 8, 2016

Attorney general Leslie Rutledge confirms that feds will not allow state to cap enrollment in Medicaid expansion

Posted By on Mon, Aug 8, 2016 at 5:04 PM

Attorney General Leslie Rutledge today confirmed what we already knew — enrollment caps for Medicaid expansion are not allowable under federal law and guidelines. 

A little background: 

During the debate over the Arkansas private option, the state's unique version of Medicaid expansion, aginners would periodically trot out doomed alternatives. These would invariably be schemes to end the private option altogether, and typically were filled with provisions that the federal government would never allow. 

For example, opponents of the private option sometimes proposed capping enrollment — disallowing future beneficiaries to sign up even if they were eligible. This was nothing more than a poison pill. The feds have been crystal clear from the beginning that this is not allowable because it does not mean the statutory requirement of furthering the objectives of the Medicaid program. If a state wants the federal Obamacare funding to expand Medicaid, capping enrollment is not an option. (A state could theoretically try to pull off a scheme like this, it would just have to fully pay for the Medicaid expansion without any help from the federal government.)

Secretary of Health and Human Services Sylvia Burwell reiterated this already-clear point to Gov. Asa Hutchinson and his team when they met in Washington. Federal guidance on this issue is a matter of public record. Legislators, if they were paying attention, have been told this information countless times. I can think of a dozen times off the top of my head when legislators heard testimony to this effect. 

For some reason, Arkansas Department of Human Services Director Cindy Gillespie asked Rutledge for an opinion on this obvious, thoroughly re-hashed question.

I asked the Health Reform Legislative Task Force leadership whether they asked for the opinion; they said they had not and knew nothing about the request. I have asked both DHS and the governor's office about the reason for the request and will update if I get a response. 

My best guess is that this was simply an effort to get a clear, official answer on the record from the attorney general so that Gillespie and company can point to this opinion every time an aginner starts the same old tired routine. 

Below is a summary of Rutledge's opinion (you can read the whole thing here): 

Q1) Would an Arkansas law that would cap the number of qualifying individuals who may receive health insurance or medical assistance through the Arkansas Works Program be valid under federal law?

Q2) Would an Arkansas law that would limit enrollment into the Arkansas Works Program to only those individuals currently enrolled in the Private Option be valid under federal law?

RESPONSE: In my opinion, the answer to each question is "no." A law limiting the number of people who may enroll in the Arkansas Works Program, thereby excluding people from the program who otherwise qualify to be part of the Medicaid expansion population under federal law, would not meet applicable federal requirements for participation in Medicaid and would in all likelihood not be approved by the Secretary of Health and Human Services. The plan would thus be invalid for purposes of obtaining and spending federal funds to cover any part of the Medicaid expansion population

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