LITTLE ROCK — The Arkansas Department of Human Services on Monday requested federal approval of proposed changes to the so-called private option, the state’s version of Medicaid expansion.

LITTLE ROCK — The Arkansas Department of Human Services on Monday requested federal approval of proposed changes to the so-called private option, the state’s version of Medicaid expansion.


The agency submitted to Health and Human Services Secretary Sylvia Burwell a proposal to amend the federal waiver that authorized the private option. DHS previously made the proposed amendments available for public comment for 30 days.


The private option uses federal Medicaid money to subsidize private health insurance for Arkansans earning up to 138 percent of the federal poverty level. The 2013 state law that established the private option requires that the proposed changes be approved and implemented by Feb. 1 of next year if the program is to continue.


Under the proposed changes, one of the benefits provided under the program, non-emergency medical transportation, would be limited to to eight trips per person per year.


Currently there is no limit on non-emergency medical transportation under the private option. The proposed limit would not apply to the medically frail.


"We do have some flexibility if people need a higher number of trips per year," DHS spokeswoman Amy Webb said Monday. "They (will) have a mechanism in place where they can ask for additional trips."


The agency also is asking for permission to create a system of "independence accounts" that would be similar to health savings accounts, and to extend cost sharing to people who earn between 50 and 100 percent of the federal poverty level. Currently, cost-sharing does not apply to people below 100 percent of the poverty level.


Under the proposed changes, a participant who earns 50 percent of the poverty level or more would be required to make monthly contributions to an independence account. Contributions would be $5 per month for people earning between 50 and 100 percent of the poverty level and would range between $10 and $25 per month for people earning more than 100 percent of the poverty level, depending on their income level.


A card would be issued to each account holder that could be used to pay co-payments and deductibles, up to the out-of-pocket limit for the person’s plan, at the point of service. People who earn between 50 percent and 100 percent of the poverty level could not be denied services if they fail to contribute, but providers could, at their discretion, deny services to people earning who earn more than 100 percent of the poverty level and fail to contribute.


The state would contribute $15 a month in rollover funds to the accounts. If a person leaves the private option and has made at least six contributions to an independence account, he or she would be eligible for up to $200 in rollover funds to help with the cost of obtaining coverage outside the private option.


"The independence accounts, we hope they will provide some additional education, help people understand what things cost and be a better overall health care consumer," Webb said.


HHS has up to 90 days to respond the request.


A little more than 194,000 Arkansans have obtained health care coverage under the private option, according to DHS.