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[MM Curator Summary]: The new 1115 will launch 3 different programs to provide enhanced support services for pregnant mothers, members with SUD and foster kids.
Arkansas Gov. Asa Hutchinson speaks during a Nov. 1 news conference at the Arkansas State Capitol alongside state Rep. Jack Ladyman (R-Jonesboro).
Screenshot of livestream
The Biden administration on Tuesday approved a new component of Arkansas’ Medicaid expansion program focused on high-risk pregnancies, rural mental health care and at-risk young adults.
Life360 Homes was one of the final outstanding portions of Arkansas’ Medicaid expansion waiver that the Centers for Medicare and Medicaid Services hadn’t approved.
CMS signed off on most of the state’s new version of Medicaid expansion — ARHOME — in December. The federal agency still hasn’t given final approval to a component focused on increasing in-patient behavioral health access.
The Life360 concept aims to provide intensive, community-based care to three groups of people in Arkansas’ Medicaid expansion population:
People with high-risk pregnancies.
Rural residents with mental illness or substance-abuse disorders.
Young adults at risk for long-term poverty, like former foster children or formerly incarcerated.
At a Tuesday morning news conference announcing CMS’ approval, Gov. Asa Hutchinson said the new program would focus primarily on rural areas of the state.
“We know that it will make a great difference for very vulnerable populations in Arkansas,” the Republican governor said. “The reason it is so important is because Arkansas’ maternal mortality rate is one of the highest in the nation. Our infant mortality rate is one of the highest in the nation.
“We’ve got to tackle these difficult problems that we’ve had for decades and decades and decades.”
Arkansas created a unique program following the 2010 passage of the Affordable Care Act, commonly known as Obamacare.
The federal health law allowed states to expand Medicaid to cover individuals whose incomes exceed the federal poverty level.
For that population, Arkansas created a program that uses Medicaid dollars to purchase private health insurance for eligible non-disabled adults between the ages of 19-64 with incomes up to 138% of the federal poverty level ($18,754 for an individual and $38,295 for a family of four).
The program has gone through various iterations, including the private option, Arkansas Works and ARHOME.
Arkansas is one of 39 states to expand Medicaid, but it is the only one using this experimental approach to incorporate the commercial health insurance market, making comparisons hard.
The program will cost north of $16 million, and as with the rest of Medicaid expansion, the state will shoulder 20% of the cost (about $3.2 million) and the federal government will cover 80%, or about $13.6 million.
ARHOME and its Life360 components are Section 1115 demonstrations. This is a part of Medicaid that allows states some flexibility to experiment with unique programs.
For high-risk pregnancies, birthing hospitals will contract with providers who conduct home visits to provide services for up to two years after birth.
The program’s outlined goal is to improve health outcomes for these infants and reduce the number of deliveries requiring Neonatal Intensive Care Unit services.
About 12,500 women on Medicaid had high-risk pregnancies in 2021, according to state data. The Life360 Homes will target women in the ARHOME program, but it will also be available to those on other Medicaid programs who are not already receiving similar services.
MENTAL HEALTH AND SUBSTANCE ABUSE
Under this component of the program, rural hospitals will provide clients with “intensive care coordination” for up to 24 months.
The hospitals will also provide community screens for social needs and receive money to operate “acute crisis units.”
About 52,000 ARHOME enrollees were diagnosed with serious mental illness or substance abuse disorders in 2021, according to state data.
To help at-risk youth, hospitals in the Life360 program can partner with community organizations to build “life skills” to help vulnerable young adults avoid long-term poverty.
The community organization can help clients find safe housing, access education, apply for jobs and obtain driver’s licenses.
These services can last for two years.
Those served must have been in foster care or incarcerated. There are about 5,700 Medicaid expansion beneficiaries in Arkansas who were foster children at one time, data show.
The Arkansas Department of Human Services is ready to begin accepting letters of intent from those wishing to participate in the program.
There will be a public comment period (which closes Monday), application window and readiness review before clients can begin enrolling for services.
State Rep. Jack Ladyman (R-Jonesboro), chairman of the House Public Health Committee, said he believed the Life360 program would be a “game-changer.”
“We have to fix our worst problems, and we feel like these are the worst problems,” Ladyman said.