The first state to use Medicaid expansion funding for private exchange insurance has attracted well over half of all eligible beneficiaries, with a healthy mix in the risk pool.
Of the 225,000 Arkansans estimated to be eligible for the Private Option, those with with incomes below 138 percent of the federal poverty level, more than 155,00 -- or 70 percent -- have applied and been determined eligible.
That surpassed expectations, said John Selig, director of the Arkansas Department of Human Services. "Clearly there was a real need in a lot of these families," Selig said in a media release.
A little over 10 percent of the applicants were found to be medically frail and placed into traditional Medicaid, but 64 percent are between the ages 19 and 44, and 43 percent are ages 19 to 34, the crucial "young invincible" segment. About 60 percent of the Private Option enrollees are women.
Four insurers have been vying for those enrollees -- Arkansas Blue Cross Blue Shield, Centene's Ambetter, QualChoice of Arkansas (which is set to be acquired by Catholic Health Initiatives) and a multi-state Blue Cross and Blue Shield plan -- although a breakdown of their private option membership hasn't been released yet. Private Option beneficiaries can also apply year-round, like Medicaid applicants.
Eighty two percent of enrollees have incomes below 100 percent FPL, which means they won't be subject to the cost-sharing that applies to the other 18 percent of enrollees with incomes between 100 percent and 138 percent FPL, as specified by the Centers for Medicare & Medicaid Services' waiver with Arkansas.
"We now know that an overwhelming majority of Arkansans in the program would have likely gone without health insurance had the Legislature not passed the Private Option," Arkansas DHS director Selig said.
Option for more states
Arkansas' Private Option model has inspired other states to bring in federal Medicaid funding to cover lower-income residents without adhering to the still-politically charged ACA.
Under a waiver approved in December, Iowa is experimenting with a Private Option policy that introduces cost-sharing. Beneficiaries between 100 percent and 133 percent FPL will have to pay premiums (equal to no greater than 2 percent of their annual income), with the possibility of reduced or eliminated premiums if they complete risk assessments and annual physicals, and they may also be responsible for copayments if they use emergency rooms for non-emergent care, with out-of-pocket costs are limited to up to five percent of income.
Pennsylvania also has a Private Option waiver proposals pending with CMS, although Medicaid managed care organizations there have reservations.
While Pennsylvania MCOs support the private option policy, the Pennsylvania Coalition of Medicaid Assistance MCOs s director, Michael Rosenstein, argued in comments on the proposal that "a new set of premiums, copays, pricing structure and other requirements" could be "problematic" for insurers' federally-facilitated exchange products. "Cost neutrality may be difficult to achieve in a full (qualified health plan) environment," he wrote.