Enrollment in the expanded part of Arkansas’ Medicaid program fell slightly in July, the sixth-straight month that the number has dropped, the state Department of Human Services reported Wednesday.

At the same time, the monthly cost to the program for those in subsidized, private insurance plans increased by more than $18 per person, to $521.07, after falling by more than $24 a month earlier, the department reported.

Known as Arkansas Works, the Medicaid expansion program covers adults with incomes up to 138 percent of the poverty level: $16,643 for an individual, for instance, or $33,948 for a family of four.

From June 30 to July 31, enrollment in the program fell by 1,517 people, to 307,155, the Human Services Department reported.

The total included 283,975 people covered under the so-called private option, which uses Medicaid funds to buy coverage in plans on the state’s health insurance exchange.

The other 23,180 people were assigned to the traditional, fee-for-service Medicaid program because they were considered “medically frail,” with health needs that private plans typically don’t cover.

Since Jan. 31, Arkansas Works enrollment has fallen by almost 27,000 people, from 334,113.

The Human Services Department has attributed much of that decrease to its efforts to identify Medicaid recipients who are no longer eligible and remove them from the rolls.

“The reduced numbers continue to reflect the improvements to the eligibility review process at DHS,” Gov. Asa Hutchinson said in a statement Wednesday.

“This, of course, is all dependent upon an effective [information technology] system, and it shows that investment in an effective IT system can yield good results and improve efficiencies in the delivery of state services.”

Earlier, Hutchinson said the state would move forward with a contract with Deloitte Consulting to provide information technology services to the Human Services Department, even though the Legislative Council declined on Wednesday morning to give the contract a favorable review.

That contract does not include the system used to determine eligibility for Arkansas Works.

But Hutchinson spokesman J.R. Davis noted that improvements to the system that handles Arkansas Works eligibility helped the state last year to clear out a backlog of applications and other overdue paperwork, allowing the Human Services Department to focus on eligibility checks.

“In general, the contracts are important,” Davis said. “These systems are important.”

Some of the decrease in Arkansas Works enrollment could also be because participants are finding jobs, department spokesman Brandi Hinkle said.

She noted that in January, the department began sending enrollees information about state job training and placement programs as it conducts annual checks of their eligibility.

That followed a mailing with similar information that went out to all enrollees in November and December.

“One of the premises of Arkansas Works is of course that we’re helping people move up the economic ladder,” Hinkle said.

Hutchinson has expressed concern about the cost of Medicaid expansion as enrollment surged past the 250,000 people state officials initially estimated would be made eligible by the expansion.

The federal government paid the full cost of the expansion during the the first three years after it took effect, from 2014 through 2016. Arkansas became responsible for 5 percent of the cost starting in January.

The 2010 Patient Protection and Affordable Care Act calls for the state’s share of the cost to rise to 6 percent next year, then continue rising each year until it reaches 10 percent in 2020.

During the fiscal year that ended June 30, the expansion’s cost totaled more than $1.9 billion, with the federal government paying all but $48.6 million, Hinkle has said.

The program’s projected cost this fiscal year is $1.8 billion, with the state paying $100 million, Hinkle said.

To shrink the program further, the state has asked the federal government for permission to move about 60,000 people off the program, starting Jan. 1, by limiting eligibility to people with incomes up to the poverty level.

The state also is seeking approval to impose a work requirement on many of those who would remain enrolled.

Under the federal waiver authorizing Arkansas Works, the state will owe money to the federal government if the cost of the subsidized private coverage from 2017-21 exceeds a limit that will be calculated using monthly per-enrollee cost caps that increase each year.

Through July of this year, the state’s per-enrollee cost averaged $525.95 a month. The cap this year is $570.50.

The cost in July included an average payment to insurance companies of just over $517 per enrollee, an increase of $18.41 compared with June.

The payment includes a premium, which varies according to the plan, region of the state and the enrollee’s age.

The program pays an additional subsidy, known as a cost-sharing reduction payment, that is tied to the premium amount and reduces an enrollee’s out-of-pocket costs for medical care.

From June to July, the average premium increased $13.35, to $374.96, while the average cost-sharing reduction payment increased $5.06, to $142.10 per enrollee.

The Medicaid program also pays directly for certain benefits, such as nonemergency medical transportation, that private plans don’t cover.

The average monthly cost of those benefits increased 15 cents, to $4.02 per enrollee.

A Section on 08/24/2017

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Medicaid expansion’s rolls shrink again in Arkansas – Arkansas Online