Consultants for Health Care Reform Task Force released a new report recommending the Private Option become a transitional or temporary program focused on “moving people upward” to opportunities. This is on the heels of an earlier report noting the Private Option will save the state over $400 million from 2017-2021.

The new report comes after several months of working closely with the Task Force to offer an alternative to the Private Option and transform the traditional Medicaid Program. Proposed tweaks to the program are said to promote more personal responsibility and accountability for enrollees and providers.

Among the changes are proposals we’ve seen before, as other states have created versions of Medicaid expansion that tend to appeal more to politically conservative policymakers. Here’s the rundown of some of the recommendations:

• An enhanced eligibility verification system to perform more in-depth eligibility screening and regular checks for changes in address or state residency;
• Mandatory health insurance premium program (HIPP) which requires Private Option eligible individuals to enroll in their employer’s plan if available, but Medicaid will pay the premium, co-pays, and deductibles;
• Enhanced cost sharing for individuals with substantial assets of at least $100 per month. The Affordable Care Act does not require asset tests as part of determining eligibility; and
• A mandatory work referral for job related activities like job training for enrollees who are not employed at least 20 hours per week.

Some of the more concerning recommendations could increase the financial burden for consumers and limit access to care. These include lockout periods, increased cost sharing requirements or premiums, and no retroactive eligibility (covering medical bills incurred 90 days prior to enrollment).

Any proposals to restrict access with lockout periods undermine the primary goal of the Private Option: to ensure all Arkansans have access to health care. Also, the research is clear–increased cost sharing is a barrier to care, particularly for low income families.

Having consistent access to coverage is critical to supporting a healthy workforce and the state’s economy. Recently, Families USA released employment data showing almost 60 percent of enrollees are working in important industries in Arkansas. We also know that there are full-time college students, non-working spouses, and people with chronic illnesses that rely on Private Option as a source of coverage.

There are also recommendations focused on addressing the quality of care and wellness of individuals in the Private Option. If these kinds of recommendations are adopted, it will be particularly important to ensure they are rolled out in a consumer-friendly manner in order to achieve any quality and wellness goals.

• Offering vision and dental benefits to enrollees who participate in other wellness activities, like visiting a PCP.
• Providing care coordination for the medically frail to improve their health and reduce costs. This proposal would change the process from completing a medically frail screener to requiring a physician determination.
• Reducing health disparities by requiring carriers to offer health care education and training for new enrollees about how to use their coverage.
• Incentivizing employers to offer insurance to Private Option enrollees by providing a one-time bonus payment.
• Creating a Wellness Report Card and Membership agreement that requires enrollees to visit a primary care doctor and tracks their important help information. Currently, this proposal is tied to premiums and co-payment for failure to comply with the agreement which could be financially burdensome or result in loss of coverage.

The success of the Private Option in reducing rate of uninsured Arkansans and the positive impact on the state economy is evident. Moving forward, it will be important for the Task Force to make policy decisions that guarantee all children and continue to have access to affordable coverage.

The report also suggests significant restructuring of traditional Medicaid and the Medicaid Program Integrity. Stay tuned for more on these recommendations.

In the meantime, AACF released 10 principles for health reform, which highlight key recommendations to ensure consumer-friendly reforms and that children and families continue to have access to high-quality coverage.

Did you miss the AACF health care forum this week? We discussed the health reform efforts in Arkansas with lawmakers, state leaders, and health policy experts. Check out a video clip of national Medicaid policy expert, Joan Alker from the Georgetown Center for Children and Families.