Medicaid expansion: When to decide?


LITTLE ROCK — The incoming leaders of the Arkansas House and Senate say Medicaid will be the No. 1 issue of the session that starts Monday — but they say deciding whether to expand the program to add 250,000 people to the Medicaid rolls is something they may or may not get to during the regular session.

House Speaker-elect Davy Carter, R-Cabot, and incoming Senate President Pro Tem Michael Lamoureux, R-Russellville, say the top issue of the regular session will be addressing Medicaid’s projected $139 million shortfall, but they say there is no rush to decide whether to expand Medicaid under the federal Affordable Care Act to include people earning up to 138 percent of the federal poverty level.

“They’re just two separate issues,” Carter said Friday.

Some lawmakers have suggested a decision on the expansion could be postponed to a special session if they believe they do not have enough information to act during the regular session. But Gov. Mike Beebe, who would have to call a special session, has said the issue should be decided in the regular session.

Beebe supports the expansion. Republicans, who will hold majorities in the House and Senate for the first time in modern Arkansas politics, generally oppose it.

In Beebe’s view the Medicaid shortfall and expansion are not entirely separate issues, spokesman Matt DeCample said Friday.

“They are two separate things from the standpoint that they deal with two separate groups of Arkansans, but they are intertwined within our Medicaid program, and federal funding that we get from the expansion will potentially help us address the shortfall,” DeCample said. “DHS predicts that there’s close to $40 million if we expand Medicaid in fiscal year ‘14 that we could move around to help address the shortfall with existing Medicaid programs.”

Beebe has proposed using part of a projected $300 million state surplus along with instituting efficiency measures and reducing services, including cuts to adult dental services and nursing home care for patients who need limited help with daily functions, to address the shortfall. Beebe has said he does not want to cut services but that DHS officials have told him the cuts will be necessary if the state does not expand Medicaid.

Carter and Lamoureux say they would prefer to avoid the cuts by using a larger share of the surplus to address the shortfall than Beebe has proposed using, regardless of whether Medicaid is expanded.

“There’s plenty of money to go around to avoid the cuts,” Carter said Friday.

Lamoureux said Friday there are “a lot of evolving rules that we don’t even know what they are” regarding the expansion and said he believes the Legislature should not act until it has enough information.

He said the Beebe administration is “attempting to link (the shortfall and expansion), hoping that one will fix the other, but it’s two separate issues.”

Amy Webb, spokeswoman for the state Department of Human Services, said the agency is concerned that if the Legislature waits too long to decide on the expansion, Arkansas’ poorest citizens could try to enroll in the state’s health insurance exchange and be denied.

“If it’s an unknown, then it has to be a ‘no’ for us right now in terms of the application, and then if we later do expand, those people have already been told ‘no.’ They may be confused. We really need to know far enough in advance that we can kind of streamline the process for the citizens so that they have as little confusion and frustration as possible,” she said.

Enrollment in the insurance exchange is scheduled to begin Oct. 1.