The governor’s proposal would lower the income requirement for Medicaid eligibility from 138 percent of the federal poverty level to 100 percent. That change would reduce the income cutoff for an individual from $16,643 to $12,060, and reduce the income cutoff for a family of four from $33,948 to $24,600.
If Hutchison’s amendments are approved by the federal government, around 60,000 Arkansas residents enrolled in Medicaid would no longer be eligible for the program.
Details matter here. This is fundamentally a state budgetary cost shifting. If an individual is on Medicaid Expansion , the state of Arkansas is on the hook for 5% of the cost of their care in 2017 and 6% of the cost in 2018. Eventually the state would be responsible for 10% of the cost of care. The Federal government pays the 90% to 95% of the cost of care for Medicaid Expansion. If an individual is on Exchange, the Feds pick up the entire subsidization costs.
Individuals who make more than 100% of the Federal Poverty line and are not eligible for Medicaid receive cost sharing and premium assistance subsidies. The Feds pay all of those costs. The individual is no worse off in Arkansas as the 1115 waiver for Medicaid expansion treated the individuals who made more than 100% FPL as if they were on Exchange for premium and cost sharing obligations. Individuals who make between 100% FPL and 138% FPL will see no difference in Arkansas. The biggest change may be a new ID card where the group or corporate policy number changes. That change will be meaningless to anyone who is not employed by an insurer or the ID card vendor.
This is an extremely low priority change to fight. It is merely an aggressive cost shifting from state budgets to federal budgets with no beneficiaries made worse off. On a scale of 1 (acknowledge)-10 (massive civil disobediance), this is a 1 on the fight scale.
Now if other states that did not have a private option 1115 waiver tried to do this, the situation would be different as beneficiaries who make more than 100% FPL would be made worse off with higher premiums and higher deductibles. But given the situation in Arkansas, this is a nothingburger.