Arkansas, the first state to establish the conservative private-plan model for expanding Medicaid under the Patient Protection and Affordable Care Act, now is looking to join several other conservative-leaning states in requiring low-income beneficiaries to make monthly contributions to their health coverage in the form of a health savings account.
The state has proposed to the CMS that beginning in 2015, its Medicaid beneficiaries would have to contribute to “health independence accounts.” Doctor with annual incomes between 50% and 99% of the federal poverty level would contribute $5 a month to their accounts, while those earning between 100% and 138% of poverty would pay between $10 and $25. The state would provide a matching contribution of $15. Money would be drawn from the accounts for copayments on medical services.
Failure to make the monthly contributions would force those earning between 100% and 138% of the poverty level to pay all cost-sharing out of their own pockets.
Traditional Medicaid features little or no cost-sharing. The Arkansas waiver proposal also would limit non-emergency transportation benefits, which is opposed by patient advocates and healthcare providers.
“It's about trying to educate this population about healthcare and healthcare costs and insurance and how it all works,” said Amy Webb, a spokeswoman for the Arkansas Department of Human Services.
Some observers say they believe the Arkansas proposal has a reasonable chance of receiving approval from the Obama administration, though it's unlikely the administration will allow cost-sharing for people below the poverty line.
The reason the administration may give it the green light is because Arkansas' Republican-controlled Legislature will need a 75% supermajority vote to renew its Medicaid expansion next year and is unlikely to do so without conservative-supported changes, which lawmakers included as part of an appropriations bill earlier this year.