On Tuesday, July 20, Arkansas submitted to the federal government an application for a waiver that would allow the state to revamp its Medicaid expansion program under the name Arkansas Health and Opportunity for Me, or ARHOME. Like the current program, ARHOME would use Medicaid dollars to provide private health insurance to low-income Arkansans through an innovative premium assistance model. In a recent piece published on the Health Affairs Blog, ACHI Health Policy Director Craig Wilson uses the ARHOME waiver application as a jumping-off point for an examination of issues surrounding the Medicaid “equal access” requirement.
State Medicaid programs have long struggled to offer reimbursement rates that are sufficient to provide beneficiary access that is similar to the general population living in the same area, even though federal law requires that access be equal. Wilson argues in his Health Affairs Blog post that the premium assistance model – which meets the “equal access” requirements in federal law – sparks questions about whether other Medicaid delivery strategies are in compliance with the law.
Legal avenues for enforcing compliance have been limited by the courts, and administrative enforcement at the federal level has been patchy. Wilson offers the following considerations for examining equal-access regulations:
- Are state-based assessments of payment rates and monitoring of access rigorous enough to determine compliance with the law?
- How do Medicaid rates compare to both Medicare and commercial insurance payment rates?
- Should the Biden administration establish a standard rate-setting methodology and network adequacy requirements for Medicaid, irrespective of the care delivery strategy?
For his detailed examination, read Wilson’s blog post for Health Affairs. For a history of Medicaid expansion in Arkansas, see ACHI’s Coverage Expansion Timeline for Adults in Arkansas.