Arkansas's new Republican governor, Asa Hutchinson, has been surprisingly dedicated to trying to keep the state's private option Medicaid expansion, which state law requires be renewed this year. He's been working to get a plan that would be approved both by the Obama administration and by the required 75 percent majority of lawmakers in each legislative chamber. He's made good progress toward the first goal.
Arkansas Gov. Asa Hutchinson said Wednesday that federal officials have approved most of his requested changes to the state's Medicaid expansion program and urged the legislature to continue it.
Negotiations over the details will continue, the governor told the state's health reform task force, but he said Secretary of Health and Human Services Sylvia Burwell "accepts the framework" that he presented to her in a meeting in Washington earlier this month. That includes premiums and copays, as well as work referral programs, for some beneficiaries. However, federal officials rejected a controversial request for an asset test that would impose a fee on beneficiaries with substantial assets, such as a house valued at $200,000.
In a letter to the governor, released Wednesday, Burwell wrote that Hutchinson's ideas for changes were "innovative" but "[i]n some cases, they also push the bounds of what is allowable under federal Medicaid law and raise concerns about potential adverse impacts on beneficiaries. However, I am hopeful that we can work together to find acceptable approaches to reform in each of your focus areas."
Hutchison needs to work with lawmakers to hammer out the details of the program within that framework that the feds have approved. Then he has to get supermajorities of 75 percent in both chambers of the legislature, which is going to be the real heavy lift. He's got his own set of maniacs, "a rump group of nine senators (or 26 House members)" who could cause trouble. Keeping them happy with too many conservative changes could endanger Democratic support. There will be a special session in April for the legislature to consider the plan. Meanwhile, the coverage of about 250,000 Arkansans enrolled in the plan (as of November 30) is in their hands.