Arkansas Medicaid

Sarah Kliff has a nice post overviewing Arkansas’s plan to use the Medicaid expansion to purchase private health insurance for low income beneficiaries. Still many questions about the details, but it appears that this would not be done under a Medicaid waiver (which typically requires cost neutrality), but would be done via section 1905(a) of the Social Security Act (the part that created Medicaid), and is a concept called “premium assistance” that is used now in some states apparently. Joan Alker has the skinny, and notes that letter of Secretary Sebelius on Dec 10, 2012 saying that HHS would not allow partial Medicaid expansions noted premiums assistance as an option….but I didn’t pay attention to this.

In a political sense, I think the Governor of Arkansas asked for something (can we use Medicaid money to pay for private health insurance?) that he thought would be denied. However, HHS said yes, or at least is in the process of saying yes. States prepared to be innovative have a whole lotta leverage right now. I care greatly about the policy, but as always, the key question is the counterfactual–as compared to what? Especially for states waivering about Medicaid expansion, I agree with trying to say yes, and given that SCOTUS made the Medicaid waiver optional, we might as well lets States try different things.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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