In Arkansas, Cost To Insure Working Poor Through ‘Private Option’ Dropping Each Month

First, a bit of background here: One of the top concerns for adopting an alternative for Medicaid expansion is, of course, rising costs. Expanding Medicaid, as has been reported here, is impossible in Texas during this 84th Legislative Session. The lawmakers aren’t going to hear it.

An alternative, however, has legs. The Obama administration has granted a handful of federal waivers that allowed the state to access the federal funds set aside for Medicaid expansion—which in Texas would be about, oh, $90 billion over the next decade—and use it to purchase health insurance for the working poor on the private market.

Arkansas was the first such state to be awarded a waiver. And Texas would be the largest. Now, there’s a report in the Arkansas Democrat-Gazette with a hopeful bit of information, especially to groups like the Texas Hospital Association, which is leading a push to find such an alternative: The cost per person has dropped every month for the past eight.

The Arkansas Department of Human Services releases updated numbers each month. The newspaper reports that the average payment for each of the 186,950 enrolled Arkansans sat at $480.26, a drop of $1.49 from October. The numbers are updated as of Nov. 15. And the month’s average payment to the carriers dropped by $1.19 to $347.84.

Further context, via the newspaper:

Under the terms of the waiver, the federal government will pay the full cost of the private option through 2016, as long as the state’s per-enrollee spending for the three years is below the cap that will be calculated using the monthly per enrollee targets.

In 2016, the monthly target rises to $523.58. If the state’s costs are above the cap, it will owe the difference to the federal government.

Arkansas created the private option as a primary way to extend Medicaid coverage to adults with incomes up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.

Most of those made eligible by the expansion receive the coverage through insurance plans sold on Arkansas’ insurance exchange, with the Medicaid program paying the premium and providing additional subsidies, known as cost-sharing reduction payments, to reduce or eliminate enrollees’ out-of-pocket spending for medical care.

In Texas, an estimated 1 million residents would qualify for something like the private option. The state of Arkansas, meanwhile, reports that its hospitals have provided less uncompensated care since the program began. And while it’s still early in the session, the news is surely a positive for healthcare groups pushing an alternative through the statehouse.

Posted in Hospitals, News.