Big development: House Speaker Jeremy Gillam and Senate President Pro Tempore Jonathan Dismang have written Gov. Asa Hutchinson asking him not to include the contentious issue of managed care of some Medicaid programs on the call for the special session to begin Wednesday.

Said a spokesman for the governor:


The Governor will review the letter, consider the request and make a decision tomorrow.

Hutchinson had said he wanted to only include his pure managed care proposal on the call. Stout opposition has arisen in the legislature in behalf of health providers who want to continue a fee for service system administered by the state. They claim they have proposals, including shifting some patients from nursing home to community care,  that can save an equivalent amount of money.

Both Gillam and Dismang say votes are sufficient to pass the governor’s “Arkansas Works” modification to the private option version of the Obamacare-financed Medicaid expansion, but no consensus exists on a way to achieve the additional savings he wants to carve out of Medicaid. The letters do NOT say, by the way, that a 75 percent vote exists for the Arkansas Works appropriation. That won’t be part of the special session, but would be taken up at the regular fiscal session to come. 


The leaders said the governor could amend the call for the session if consensus emerged on managed care.

I think, as some predicted over the weekend, this session just blew up. I also think it is fair to say that the much bigger issue — the Medicaid expansion — hangs in the balance as this plays out. Putting this issue in with a 75-vote issue in the same session? Whew.