As a mom of new crawler, I regularly find myself on the watch for what we call “head bonks” as Maddie discovers open doors or new pieces of furniture.  But the circles I’m turning to keep up with a 9-month old are nothing compared to staying on top of the changes happening in the Arkansas health care system.  Here is a partial list:

Threat of federal Medicaid cuts 

We dodged a bullet with the most recent debt ceiling agreement, but the debate is far from over.  Medicaid is spared in the short run, but make no mistake, cuts are very much still on the table in Washington.  See our take on the recent agreementhere.

Medicaid Payment reform (“Medicaid Transformation“)

Arkansas is one of very few states without a Medicaid shortfall — yet — but we expect a shortage of roughly $60 million in 2013 and over $200 million in 2014.  State leaders are working on new ways of paying for services to control rising costs. The idea is to change the way providers are paid to, hopefully, avoid cutting eligibility, services, or payment rates that could impede access to care. Payments to providers would move away from fee-for-service to more quality, coordinated care.  Many decisions are plans are still very much in the early stages, and while the aim is a good one, it’s difficult to say exactly how this will help or harm families until we have more details.  For more information on progress to date, see meeting documents and the proposed work plan here.

Implementing the ACA  – Medicaid and the Health Benefits Exchange

Of course, we have more changes on the horizon for 2014 as we seek to help the half million uninsured Arkansans access insurance coverage.  About half of these Arkansans will be newly eligible for Medicaid, according to the Arkansas Center for Health Improvement.  More than 300,000 will be eligible for subsidies to purchase coverage on a Health Benefits Exchange, or a marketplace to shop for health insurance.  While necessary authorizing legislation failed to pass during the 2011 session for the state to operate its own Exchange, the Insurance Department has continued with planning efforts.  A robust stakeholder input process is underway, including multiple workgroups, a cross-group steering committee, and public input forums around the state.  (Of course, if the state does not pass authorizing legislation during the fiscal session, it’s pretty clear from recent regulations that the federal government will step in and run the Exchange for us to ensure it’s up and running by January 2014.)

How this benefits exchange is designed – coordination with Medicaid, benefits design, affordability, access, trusted supports to help consumers-will be critical to Arkansas families.  Want to weigh in? Check out progress to date and various stakeholder groups at  https://hbe.arkansas.gov/  You can also provide input until August 25 through an online survey.

Other efforts to get our system ready for 2014 include a task force to look at the healthcare workforce, the State Health Alliance for Records Exchange to create and improve the secure exchange of health information, and reviews on insurance rates.

Cutting red tape in ARKids First

Last but not least, AACF and the Finish Line Coalition have not forgotten about Act 771, which passed earlier this year to “cut the red tape” in ARKids First.  The aim is for several pieces of this to be implemented by the end of the year, and the coalition is working with DHS officials to move forward.

There will be no shortage of challenges and opportunities on the health care front for child advocates in the coming months.  Help us watch out for the “head bonks” by staying with AACF and the Finish Line Coalition as we work to help the system make progress for families.