Arkansas governor seeks new restrictions on Medicaid plan

LITTLE ROCK, Ark. (AP) — Arkansas would move about 60,000 people off its hybrid Medicaid expansion and require some participants to work under a series of restrictions the governor proposed Monday, even as the future of the federal health overhaul remains murky.

Republican Gov. Asa Hutchinson said he'll ask the federal government to approve the new restrictions by June and hopes to implement them by 2018. More than 300,000 people are on Arkansas' hybrid program, which uses Medicaid funds to purchase private insurance for the poor. The program was created in 2013 as an alternative to expanding Medicaid under the federal health law.

Hutchinson is pushing for the changes even as fellow Republicans in Washington are split on how to follow through on campaign promises to repeal and replace the health overhaul. The proposed restrictions are on top of other changes to the program championed by Hutchinson and approved last year.

"I don't think we can wait on the federal government," Hutchinson told reporters at a news conference. "I think we need to continue our reforms now."

Hutchinson's proposal would lower the eligibility cap for the program from 138 percent of the federal poverty level to 100 percent, which he said would remove about 60,000 people. Hutchinson said they would be eligible for subsidies to buy coverage through the insurance marketplace under the federal health law.

Hutchinson said the work restrictions would be similar to other programs, such as food stamps, which require non-disabled participants to be employed, undergo job training or volunteer. The program currently requires the state to refer beneficiaries to job placement and training programs, but they're not required to participate.

"This is a work requirement that will encourage those who are abled bodied to work and to give them the tools they need in order to move up that economic ladder," Hutchinson said.

Arkansas and other Republican states had been rebuffed by the Barack Obama administration on work requirements, but are hoping for more flexibility from President Donald Trump. A similar proposal from Kentucky was submitted last year and is pending before the Trump administration.

The other changes Hutchinson says he'll seek include expanding a provision approved last year aimed at moving participants to employer-sponsored insurance, with Medicaid expansion funds paying for premium costs. Another change would give the state greater control for determine eligibility for participants in the program.

Hutchinson said he'll have to call a special session for lawmakers to take up legislation related to the changes. The governor said he'll likely call the session shortly after the Legislature formally adjourns this year's session in May.

Arkansas is moving forward with the proposals as it faces uncertainty about the Medicaid expansion funding, but also the marketplace used to purchase subsidized insurance. Arkansas' hybrid Medicaid expansion plans are purchased through the marketplace.

"I think Arkansas is uniquely at risk here," said Joan Alker, executive director for the Center for Children and Families at Georgetown University.

The proposals raised concern among health advocates in Arkansas, who said the work requirement counterproductive.

"I do think it's a realistic concern that we could be requesting some changes or asking for some things that could put us in a more challenging position in the future," said Marquita Little, health policy director for Arkansas Advocates for Children and Families.

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