The three-year evaluation of the Private Option is the first direct comparison of commercial insurance with Medicaid since Medicaid’s inception in 1965. Through Arkansas’s use of premium assistance, and as a consequence of the rigorous CMS evaluation requirements of the waiver, previously unfeasible direct comparisons of system performance have been enabled.
Arkansas Medicaid achieves comparable participation in its network, compared to QHPs, for both primary and specialty providers. However, likely due to markedly higher provider payment rates and more active enrollee management, the network adequacy and clinical performance of the QHPs exceeds that of Medicaid. These differences have an impact on the uptake of clinical preventive services, appropriate disease management, and utilization of emergency room services. For those with Higher Needs, perceived barriers to getting care when needed and getting necessary tests and treatments are persistent for Medicaid.
