LITTLE ROCK — State Department of Human Services officials on Wednesday urged the AARP to lobby the state Legislature in support of expanding the state Medicaid program and overhauling the state’s health care payment system.
DHS Director John Selig and state Medicaid Director Andy Allison made their pitches for the two proposals at a summit on long-term care co-sponsored by DHS and AARP Arkansas at the Clinton presidential library.
"You’ve got a lot of new legislators coming in, people running for office," Selig said. "Understandably, most of them really have no idea what Medicaid does. It’s a complicated program, and we don’t expect people to understand exactly how Medicaid works, but my hope is that they’d understand what the impact is and how important it is in the community. You all know that, and I would just really encourage you to make sure people are well educated."
Expanding Medicaid to include people earning up to 138 percent of the federal poverty level, a provision of the federal Affordable Care Act that the U.S. Supreme Court has ruled must be optional for states, would bring hundreds of millions of federal dollars into the state and should lessen the impact of a shortfall of between $250 million and $400 million in the state Medicaid program that is projected to hit the state in the next fiscal year, Selig said.
Selig also said the state’s initiative to implement a new payment system for health care providers, in which providers will be paid for episodes of care rather than for each individual service, should lessen the impact of the shortfall. He told reporters later the initiative is projected to save the state $15 million in 2014 and more in later years.
Allison and Selig said that other than reforming the payment system, the options for addressing the Medicaid shortfall are cutting services, raising taxes, passing costs on to patients of private providers, reducing payment for providers and micro-managing care — none of which would be easy.
"In most states that they’ve faced this cliff, after lots of gnashing of teeth they’ve had to do a combination of significant-to-severe belt tightening and raising new resources," Selig said. "Nobody has dealt with their Medicaid shortfall by just cutting services because (of) the kinds of services you talk about cutting."
Those services would be limited to what the federal government considers optional services, such as prescription drug coverage or nursing home care, he said.
"It’s not stuff around the edges, where you we could say we could give two hours less of this or make it a little tougher to get that. These are core programs for seniors, for children, for people with disabilities," Selig said.
An audience member asked in a written question if Arkansas has enough doctors to care for an influx of new patients. Allison said he believed that with the help of others in the medical field, doctors should be able to care for them — but he said that issue should not decide whether the state expands Medicaid.
"I don’t think that the question of whether there are enough doctors is important enough to say, "Therefore we shouldn’t provide the financial resources,’" he said. "That to me sounds a whole lot like, ‘I want to protect what I have and make sure the poor can’t get it.’"
Herb Sanderson, AARP associate state director for advocacy, said after the summit that the organization for people age 50 and older — which has about 350,000 members in Arkansas — supports expanding Medicaid and is "very interested" to see how the payment reforms develop.
"We want definitely to be a partner in anything that would prevent massive cuts to Arkansans," he said.
Republican legislators have expressed reservations about expanding Medicaid and revamping the health care payment system. State Rep. John Burris, R-Harrison, said Wednesday that Selig and Allison are likely to face some resistance in the Legislature.
"I think what they’ll find is that you’ve got a lot of people running for office that will be elected that have legitimate concerns about the direction of our country and most importantly the level of spending, unsustainable spending, that we’re seeing in our country and how that will affect our state," he said.