Arkansas lawmakers vote to scale back hybrid Medicaid plan

LITTLE ROCK, Ark. (AP) — Arkansas lawmakers voted Wednesday to scale back the state's first-in-the-nation hybrid Medicaid expansion under a plan that would move 60,000 people off the program and require some remaining participants to work.

The changes are part of an effort in Republican-leaning Arkansas to take advantage of President Donald Trump's willingness to give states more flexibility in restricting coverage. Arkansas is pursuing the changes despite GOP efforts in Washington to repeal the Affordable Care Act, which enabled the state's program.

"Just because there's uncertainty doesn't mean we shouldn't improve the program," said Senate President Jonathan Dismang, a Republican. "Until Congress makes changes, repeals the Affordable Care Act and replaces it, we need to work underneath what we have and we'll deal with those changes whenever they arise."

More than 300,000 people are currently on the program, which was created in 2013 as an alternative to expanding Medicaid under the federal health law. The program uses Medicaid funds to purchase private insurance for low-income residents, and Arkansas was the first state to win approval for such a hybrid approach.

Republican Gov. Asa Hutchinson in March proposed the new restrictions, which must also be approved by the federal government. Hutchinson said he'd likely sign the measures into law Thursday.

"We're in a position to make adjustments now that I believe will fit in very well with the reform efforts they're trying in Washington," Hutchinson told reporters. "I'm very confident where we are. I think we will be national leaders in this effort, but also we have to look out for the state of Arkansas."

The changes, laid out in identical bills that cleared the House and Senate on Wednesday, would lower the eligibility cap for the program from 138 percent of the federal poverty level to 100 percent. Those moved off the program would still be eligible for subsidies to purchase health insurance coverage from the online insurance marketplace established under the federal law.

The work requirement would be phased in over a two-year period and apply to able-bodied participants ages 19 to 49. Participants would be required to work at least 20 hours a week or 80 hours a month, volunteer or participate in job training or other training programs. The state plans to submit its request to the federal government by June and hopes to implement the changes next year.

Arkansas' program has been credited for cutting how much hospitals pay for caring for uninsured patients and for reducing the number of people in the state without coverage.

Democrats said they're worried the new restrictions will weaken those advances.

"It does have the possibility of our losing ground rather than gaining ground," Democratic Sen. Joyce Elliott said.

Experts and health advocates questioned the timing of Arkansas' plan. They note legislation is pending in Congress to repeal the federal health care law, as well as the uncertainty over whether Trump could take action to undermine the marketplaces set up under the federal law to purchase coverage.

"I think it's very perilous for the state to be doing this at this moment in time," said Joan Alker, executive director of the Center for Children and Families at Georgetown University. Alker said that, depending on what happens in Washington, Arkansas' plan could leave thousands currently on the expansion without coverage.

Arkansas' hybrid expansion has sharply divided Republicans, who control both chambers of the Legislature, since it was created four years ago. But the proposed restrictions won support from some conservatives who have called for ending the expanded coverage altogether.

"I think it moves the needle in the direction in which I wanted to see it move, which is fewer people enrolled on the Medicaid expansion program," said Republican Sen. Scott Flippo.

Follow Andrew DeMillo on Twitter at www.twitter.com/ademillo