A state advisory committee voted Monday to approve Arkansas Department of Human Services recommendations for 2022 performance goals for health insurance providers participating in the next version of the Arkansas Medicaid private options program. ‘State.
The state’s expanded Medicaid program, dubbed ARHOME, is scheduled to take effect Jan. 1. Officials expect the program to gain federal approval in the coming days.
ARHOME, which stands for Arkansas Health and Opportunity for Me program, will provide Medicaid-funded private health insurance to low-income people. The current version is called Arkansas Works, which had 330,421 registrants as of Nov. 1, according to the Department of Human Services website.
William Golden, medical director of the state’s Medicaid program, told the Health Accountability and Economic Outcomes Oversight Advisory Committee that the department chose to base its target metrics for health insurance providers on figures for 2019 and 2020.
The panel was created by the ARHOME legislation, law 530 of 2021, so it only becomes an official entity on January 1st. Its members include legislative committee chairs, state agency heads, Human Services Secretary Cindy Gillespie, Surgeon General Greg Bledsoe, Arkansas Minority Health Commission chief and community stakeholders.
For measures where a higher number is preferable, such as cancer screenings and preventive care provided to eligible populations, the target will be the highest percentage achieved by any qualifying health plan in 2019 or 2020.
For example, in 2019, Blue Cross Blue Shield screened the highest percentage of women aged 50-64 for breast cancer in 2019 at 54%, so all insurers should now meet this mark.
For metrics where a lower number is better, such as hospital admission rates for chronic conditions such as diabetes and asthma, the target would be the lowest percentage achieved by a qualified health plan in 2019 .
A qualified health plan refers to a health insurance plan that meets the requirements established by the federal Affordable Care Act, or Obamacare.
This approach takes into account the decline in the use of health services and the decline in hospital admissions among Americans in 2020 as a result of the coronavirus pandemic, Golden said.
The Department of Human Services is considering a variety of potential consequences for insurers that do not meet targets, including corrective action plans for persistent poor performance and financial penalties beginning in 2023.
Gillespie said “it will be a good job of increasing the numbers,” but it will lead to better health outcomes for many Arkansans.
“If we’re able to get to the high of 19 or 20 in most of these categories…we’ll see significant improvement. There’s some pretty big swings here,” she said.
State House Public Health, Welfare and Labor Committee Chairman Rep. Jack Ladyman, R-Jonesboro, introduced the motion to endorse the department’s recommendations.
Dennis Smith, senior adviser for Medicaid and health care reform at the Department of Human Services, said after Monday’s meeting that officials were working on the final terms for federal approval of ARHOME.