Arkansas today submitted proposed amendments to the private option for federal approval. In order to pursue the private option — the state’s unique version of Medicaid expansion which uses Medicaid funds to purchased private health insurance for low-income Arkansans — the state first had to secure approval for what’s known as an 1115 waiver, a waiver of federal Medicaid rules allowing the state to experiment with a new approach. For the second year of the program, 2015, Arkansas is requesting three changes: 

1) Health Independence Accounts — private option beneficiaries will make monthly contributions to these accounts in order to waive cost sharing payments (see here for more details on how the HIAs — which are not Health Savings Accounts, despite the tendency of many media accounts to describe them as “HSA-like” — will operate). I’ll have more on HIAs in a forthcoming post.


2) Cost-sharing for private option beneficiaries between 50-99 percent of the federal poverty line. In Year One, the private option had no cost sharing below the poverty line, only for beneficiaries between 100-138 percent of FPL. Next year, the state is requesting to amend the waiver so that cost-sharing is allowed for beneficiaries between 50-138 percent of FPL. The cost-sharing in question is only the amount allowable under Medicaid law and will be tied to the Health Independence Accounts. More details here.   

3) Limits to non-emergency medical transportation (see here for more on the NEMT benefit). Unlike Iowa, which got a one-year waiver allowing the state to stop offering the NEMT benefit to certain beneficiaries altogether, Arkansas is asking that the NEMT benefit be limited to eight trip legs per year for private option beneficiaries (so that would be four visits to the hospital, say, as there and back counts as two trip legs). People deemed medically frail and routed to the traditional Medicaid program will have no trip limits; this only applies to private option beneficiaries in private plans. If beneficiaries have a legitimate need, they can request additional transportation beyond the trip limit “through an extension of benefits process” with the Medicaid program. Hopefully this process will avoid a scenario in which a beneficiary in need is unable to get to a medical provider. Republicans in favor of limiting NEMT argue that the unlimited benefit leads to waste, fraud and abuse from the transportation providers; if so, perhaps the new process in place will curtail over-utilization. 


These changes, along with the “Bell amendment” banning state-appropriated funding on outreach for the Affordable Care Act, are requirements for continuation of the private option because of special-language amendments added to the private option legislation during the 2014 fiscal session. Federal approval (a must for continuation of the private option) is thought to be likely. The feds have 90 days to respond. 

Here are the proposed terms and conditions for


for the the state’s cover letter to the feds and 
for public comments and responses.