LITTLE ROCK — Gov. Asa Hutchinson on Monday outlined four changes to the state’s Medicaid expansion program that he will ask President Donald Trump’s administration to approve, including a work requirement and a lower maximum income for recipients.
In a news conference at the state Capitol, Hutchinson said he has directed the state Department of Human Services to file requests for federal approval to add new restrictions to Arkansas Works. He said the restrictions, if approved, would save the state and federal governments money, lower the number of people enrolled in the program and help people move up the economic ladder.
The governor said he went over the proposed changes with U.S. Health and Human Services Secretary Tom Price on Saturday and said Price "indicated that they’re consistent with reform efforts they want to see happen” although he could not approve them without seeing the requests in writing.
Arkansas Works, formerly known as the private option, provides government-subsidized private health insurance, mostly funded by the federal government, to low-income Arkansans. It was created as an alternative to the expansion of state Medicaid rolls envisioned in the federal Affordable Care Act.
Hutchinson said said he wants approval to:
— Add a work requirement.
The governor said he wants to require that non-disabled adults be employed, enrolled in state-provided worker training or completing a to-be-determined number of hours of volunteer work per week to qualify for the program.
He said he wants the requirement to be similar to the work requirement in the Supplemental Nutrition Assistance Program. This would “encourage those that are able-bodied to work and … give them the tools that they need in order to move up that economic ladder,” he said.
— Make the program available to people who earn up to 100 percent of the poverty level, instead of the current 138 percent.
Hutchinson said about 20 percent of the 311,000 people currently enrolled in the program, or about 62,000 people, would be shifted to the individual marketplace under this proposal. They would be eligible for subsidies but would have to pay premiums of 2 percent of their income, so “it is encouraging personal responsibility,” he said.
The federal poverty level is an annual income of $11,880 for an individual or $24,300 for a family of four.
— Create a program to encourage people who earn between 75 percent and 100 percent of the federal poverty level and work for a small business to move to employer-sponsored insurance.
The state would provide premium assistance up to the amount it would have provided under Arkansas Works and provide incentives to employers to offer insurance.
— Make Arkansas an “assessment state,” meaning that the state would assess all applicants to determine their eligibility.
Currently, the federal government is determining the eligibility of Arkansans who apply through the federal HealthCare.gov website. Hutchinson said previously it was necessary for Arkansas to rely on the federal government to help with the assessments, but because DHS has cleared a backlog of cases, the assessments can all be done in the state now.
Legislation would be needed to change the income eligibility cap and make Arkansas an assessment state. Hutchinson said he expects to call a special session to ask the Legislature to approve bills on those issues.
The governor said the changes he is seeking would take effect Jan. 1. He said he expects the program to continue unchanged through this calendar year.
The long-range future of Medicaid expansion is unclear, however. A U.S. House bill released Monday would end the federally funded expansion of Medicaid in 2020.
Senate President Pro Tem Jonathan Dismang, R-Searcy, said Monday the proposed changes would be “a great step in the right direction for the program.”
Sen. Bryan King, R-Green Forest, who has opposed Medicaid expansion from the beginning, said the governor is proposing to continue an unsustainable program with only “minor changes.”
Senate Minority Leader Keith Ingram, D-West Memphis, said he wants more information about how the changes would affect low-income families.
“We’ve come so far in cutting our uninsured to historic lows. I’d hate to do anything to jeopardize that,” he said.