• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

I’d like to think you all would remain faithful to me if i ever tried to have some of you killed.

Republican obstruction dressed up as bipartisanship. Again.

“More of this”, i said to the dog.

Putting aside our relentless self-interest because the moral imperative is crystal clear.

The party of Reagan has become the party of Putin.

When your entire life is steeped in white supremacy, equality feels like discrimination.

Republicans don’t want a speaker to lead them; they want a hostage.

Something needs to be done about our bogus SCOTUS.

I did not have this on my fuck 2022 bingo card.

A Senator Walker would be an insult to the state and the nation.

T R E 4 5 O N

Some judge needs to shut this circus down soon.

Impressively dumb. Congratulations.

Just because you believe it, that doesn’t make it true.

Is it negotiation when the other party actually wants to shoot the hostage?

Jesus, Mary, & Joseph how is that election even close?

I’d try pessimism, but it probably wouldn’t work.

Being the leader of the world means to be the leader of peace.

The poor and middle-class pay taxes, the rich pay accountants, the wealthy pay politicians.

If you are still in the GOP, you are an extremist.

Their freedom requires your slavery.

Within six months Twitter will be fully self-driving.

I was promised a recession.

JFC, are there no editors left at that goddamn rag?

Mobile Menu

  • Winnable House Races
  • Donate with Venmo, Zelle & PayPal
  • Site Feedback
  • War in Ukraine
  • Submit Photos to On the Road
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • Balloon Juice 2023 Pet Calendar (coming soon)
  • COVID-19 Coronavirus
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • War in Ukraine
  • Garden Chats
  • On The Road
  • 2021-22 Fundraising!
You are here: Home / Anderson On Health Insurance / The next Arkansas 1115 waiver

The next Arkansas 1115 waiver

by David Anderson|  January 6, 20168:37 am| 4 Comments

This post is in: Anderson On Health Insurance, Free Markets Solve Everything, Fuck The Poor, World's Best Healthcare (If You Can Afford It), Meth Laboratories of Democracy

FacebookTweetEmail

Arkansas is submitting another round of waivers for their private option Medicaid expansion.  There is one thing I don’t see CMS granting, and a couple of fights but the waiver as a whole is fairly straightforward.  The biggest problem with the waiver is that it is unnecessarily expensive.  Straight up Medicaid expansion would have been cheaper than paying providers Exchange rates but that has never been on the table.  As Arkansas needs to pay 5% and then 10% of the total expansion costs, switching back to a straight expansion would get increasingly attractive as a means of reducing the state government cost exposure.

So let’s look at the details:

    • Requiring individuals eligible for Medicaid to enroll in employer-sponsored insurance where available, with Medicaid covering employees’ costs that would exceed Medicaid levels

This is straight forward. Medicaid should be the payer of last resort, so if ESI coverage is available, it should be the primary payer. Medicaid will be used as secondary coverage to reduce cost sharing to no more than 5% of total income. Coordination of Benefits is an administrative pain in the ass, but this happens everywhere.

    • Requiring premium payments for beneficiaries with incomes above 100% of the federal poverty level, with a consideration of contributions for those with incomes above 50%.

CMS has approved 2% premium requirements for people making more than 100% FPL. This will get approved. Premiums for people making under 100% FPL are solely designed to force people out of the program as the administrative cost of collecting a $3 per person per month premium means there is no net payment by the individual for actual medical care.

    • The state would offer enhanced coverage and other incentives for those who comply and meet goals set in Healthy, Active Arkansas, a Hutchinson initiative encouraging wellness.

This is not a big deal, it is a wellness program that CMS has approved in other states. I don’t think it moves the needle all that much on cost or quality outcomes, but it does not hurt as long as participation is not mandatory.

    • Care coordination for medically frail individuals

This is a good thing in and of itself.

    • Verifying beneficiaries’ incomes through enhanced data matches.

This is an administrative back-end plumbing tweak. It will most likely be used to force marginal cases out of Expansion and onto the Exchanges. The state wants to look at more databases to build an income profile (food stamps, tax records, lottery winnings etc)

Here are some of the areas where I think fights will occur:

    • Eliminating the current retroactive eligibility that allows new beneficiaries to be covered for expenses incurred 90 days before they were enrolled.

Medicaid is assumed to be the payer of last resort and there is a presumption of eligibility. Medicaid in most states is not concerned about adverse selection problems as they assume that they are the dumping ground for adverse selection. Medicaid has a bad risk pool. The problem is Arkansas is trying to use an at risk insurance model for Medicaid where presumptive eligibility creates massive adverse selection problems. I could see CMS agree to a 30 day walkback from the date of application but not the elimination of presumptive eligibility.

    • Restricting coverage or requiring greater cost sharing by individuals with substantial assets.

Medicaid expansion’s only eligiblity requirements are citizenship (or 5 years of legal residency) and income. There are no asset tests in PPACA. I am having a hard time seeing CMS approving a waiver that institutes asset testing even if the threshold is a million dollars (ie the lottery winner who now does not work and is on Medicaid). If the goal of Expansion is to help the working poor, creating asset tests traps people in a narrow income range as they can’t afford a newer car, or they can not afford to save against expected but unknown shocks.

This is the area of straight up disapproval in my eyes:

    • Implementing work training referral requirements with a continued discussion with President Obama’s administration on specific work requirements.

CMS has been vehement against tying eligibility to work requirements. At the most, CMS has told states that they are free to set up and offer voluntary work training programs that are targeted at Medicaid Expansion populations with state money but eligibility is independent of work status.

FacebookTweetEmail
Previous Post: « Open Thread: Skin (or Chromosomes) in the Game
Next Post: Wrapping around services »

Reader Interactions

4Comments

  1. 1.

    NeutronFlux

    January 6, 2016 at 9:16 am

    Thanks

  2. 2.

    MomSense

    January 6, 2016 at 10:02 am

    Work requirements are all the rage but what about people who live where there are no jobs? In Maine the governor has a volunteer option to satisfy the 20 hour per week work requirements for food stamps but people are finding it tough to pay for the gas to get to a volunteer job. It’s just more shame the poor BS that ends up causing real hardship.

  3. 3.

    Mnemosyne

    January 6, 2016 at 11:36 am

    @MomSense:

    Not only that, what about people who can’t work due to their health? My coworker’s sister (who I’ve mentioned before) can’t even get a fast food job because her grand mal seizures are poorly controlled by medication. Subway let her go because she had a seizure on the job and freaked everyone out, and anyplace that has any kind of oven or grill sure as hell isn’t going to take her since she’s a safety risk.

    Of course, if you look at her, she *appears* to be healthy, so some idiot somewhere is probably wondering why she’s lounging around on disability and Medicaid.

  4. 4.

    MomSense

    January 6, 2016 at 12:17 pm

    @Mnemosyne:

    Absolutely. I hear so many bogus things about disability. It is difficult to get approved and you have to have a work history. Medicaid makes it possible for people to work who would absolutely not be able to without it. Also, too why would you want your meal prepared or served by someone who can’t access basic medical care??

    Can we also discuss the need for reliable child care and work schedules that make it possible for parents to plan? Republicans love to shame low income people but they never shame the employers who treat them so callously.

Comments are closed.

Primary Sidebar

🎈Keep Balloon Juice Ad Free

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal

2023 Pet Calendars

Pet Calendar Preview: A
Pet Calendar Preview: B

*Calendars can not be ordered until Cafe Press gets their calendar paper in.

Recent Comments

  • David 🌈☘The Establishment☘🌈 Koch on Eve of Destuction (Jan 27, 2023 @ 6:48pm)
  • Mr. Bemused Senior on Eve of Destuction (Jan 27, 2023 @ 6:48pm)
  • kalakal on Banned Book Drops (Open Thread) (Jan 27, 2023 @ 6:47pm)
  • Geminid on Eve of Destuction (Jan 27, 2023 @ 6:47pm)
  • UncleEbeneezer on Eve of Destuction (Jan 27, 2023 @ 6:47pm)

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year
View by Past Author

Featuring

Medium Cool
Artists in Our Midst
Authors in Our Midst
We All Need A Little Kindness
Favorite Dogs & Cats
Classified Documents: A Primer

Calling All Jackals

Site Feedback
Nominate a Rotating Tag
Submit Photos to On the Road
Balloon Juice Mailing List Signup

Front-pager Twitter

John Cole
DougJ (aka NYT Pitchbot)
Betty Cracker
Tom Levenson
TaMara
David Anderson
ActualCitizensUnited

Shop Amazon via this link to support Balloon Juice   

Join the Fight!

Join the Fight Signup Form
All Join the Fight Posts

Balloon Juice Events

5/14  The Apocalypse
5/20  Home Away from Home
5/29  We’re Back, Baby
7/21  Merging!

Balloon Juice for Ukraine

Donate

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • YouTube
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2023 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!