MEDICAID EXPANSION PROGRAMS

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MEDICAID EXPANSION
PROGRAM
S


Arkansas
Department of Human Services

Strategic Plan
-

SFY 2011

(Base Year for 2012)

Mission Statement:

Medicaid Expansion Programs

Total Budget:


$
5
5
,
123
,
335.82

(Tot.)

$
40
,
386
,
110.
82 (Fed.)

$1
4
,
737
,
225
.00 (Tob.)

The goal of the Medicaid Expansion
P
rogram
s (MEP)
is to create a separate and distinct
component of the Arkansas Medicaid Program that improves the health of Arkansans by
expanding health care coverage and benefits to populations as established by Initiate
d Act 1 of
2000.

Program Component Description:


Pregnant Women’s Expansion

(PWE)



Program
Budget:

$
5,734,933.61

(
11
%)

$4,374,033.86 (Fed.)

$1,360,899.74 (Tob.)

This program expands Medicaid coverage and benefits to low
-
income
pregnant women.



Increased the income eligibility limit from 133% to 200% of the federal poverty level



Program implemented November 1, 2001

Goal:
Increase Program Utilization

PWE
-

Utilization

Goal 1: To increase the percentage of enrolled women who
receive at least two prenatal visits.

Goal 2: Beneficiaries currently enrolled in the Pregnant Women’s Expansion Program will utilize
services at least at the same level as the average pregnant Medicaid beneficiary.

Measurable Objectives & Progress:

PWE

-

Utilization

1

The Department is working with RAND to establish the baseline percentage from which
future progress will be measured. The most significant challenge is the fact that services
are billed under a “Global Fee Structure” which masks detailed

service data.

DHS is enhancing the administrative resources assigned to perform data mining, tracking
and analysis of PWE
services and benefits.


2

The MEP is meeting this goal with both groups reporting services at the 98% level.

DHS will continue

to analyze the payment/benefit data to determine the exact number
and type of services provided to this population.

Program Component Description:


Hospital Benefit Coverage


Budget:

$
8,659,980.06

(
17
%)

$6,604,966.79 (Fed.)

$2,055,013.27 (Tob.)

This
program offers expanded hospital reimbursements and benefits to Adults ages 19


64.



Increased the number of benefit days from 20 to 24 and decreased the co
-
pay on the
first day of hospitalization from 22% to 10%.



Program implemented November 1, 2001

Goal:

Hospital Benefit Coverage

Even though this initiative does not have a specific outcome goal, it has the impact of reducing
uncompensated care, cost sharing and patient liability for Medicaid beneficiaries receiving
hospital care.

Measurable Objectives & Progress:

Hospital Benefit Coverage

1

The agency will identify the proportion of participants using the maximum number of
hospital benefit days.

DHS is enhancing the administrative resources assigned to perform data mining, tracking
and analysis of MEP services and benefits.

Program Component Description:


ARSeniors Program



Program
Budget:

$
6,006,099.56

(
11
%)

$3,190,722.92 (Fed.)

$2,815,376.64 (Tob.)

This program expands non
-
institutional coverage and benefits to Medicare beneficiaries age 65
and over.



Incrementally increase coverage to the 65 and over population



Implemented November 1, 2002 at 75% of QMB Level



Increased to 80% of QMB Level effective January 1, 2003

Goal:

ARSeniors Program

Goal 1: Enrollment in the ARSeniors Program will increase by 15 percent annually.

Goal 2: Program participants will utilize services at least at the same level as the
average dually
eligible beneficiary.

Measurable Objectives & Progress:

ARSeniors Program

1

DHS will work with RAND to identify a new denominator for the enrollment formula.

The Department will create an internal workgroup during the first quarter of SFY 2011 to
update Arkansas’s estimate of the number of seniors potentially eligible to participate in
this program.

2


DHS will increase the number of program participants
through innovative enrollment
techniques and educate them about the services available through their expanded
coverage.

The DHS County Operations Division has initiated a new tape matching process with the
Social Security Administration to identify seniors eligible for the Medicare Part D Low
Income Subsidy for prescription drugs. The agency is currently receiving 300 “mat
ches” a
week. These applications are being processed from a centralized unit in Osceola.

Program Component Description:


ARHealthNetworks


Program
Budget:

$
31,906,932.60

(
61
%)

$24,808,692.25 (Fed.)

$ 7,098,240.35 (Tob.)

This program provides a limited benefit package to adults ages 19
-
64 with income at or below
200% of the FPL and working in small businesses.



This population will be covered through a federal waiver program which provides
eligible small employers and sole

proprietors with health coverage.



The ARHealthNetworks Program was implemented in January 2007.

Goal:

ARHealthNetworks
-

Enrollment

Goal 1: Enrollment in ARHealthNetworks will increase by 75 new employers annually and 400
new members per month.

Measurable Objectives & Progress:

ARHealthNetworks
-

Enrollment

1

RAND requested that DHS begin tracking ARHealthNetworks service usage data to
determine the percentage of participants using the maximum number of benefits
available through the plan.

NovaSys has developed the necessary reports to begin reporting this data to RAND on a
semi
-
annual basis.

2

Market the expansion of the program to sole proprietors/self
-
employed individuals.

NovaSys has initiated mass
-
marketing via radio announcements
to promote this change.