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Benefits Rollback Bill Would Cost Nearly $20 Million in Red Tape, Analysts Say

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Ohio is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The Ohio Senate bill reportedly would curb fraud, but a 2015 investigation found that fraud amounted to less than 1% of administered SNAP benefits and less than the cost of the audit itself.


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Two lines of cars wait for food assistance at the All People’s Fresh Market in Columbus. Officials say covid-related food insecurity is growing in Ohio.Photo: Marty Schladen, Ohio Capital JournalA legislative proposal to restrict eligibility for social safety net programs like food stamps or Medicaid would cost nearly $20 million to implement, according to state policy analysts.

The Ohio Legislative Service Commission, a nonpartisan arm of the state legislature that evaluates policy proposals, estimated a plan to require photo identification on every Supplemental Nutrition Assistance Program card would cost about $15 million to implement and $930,000 annually to maintain.

Senate Bill 17 would end policies known as “categorical eligibility” and “simplified reporting” that lower income reporting burdens on SNAP recipients along with the bureaucratic burden on state government. The new, more onerous income reporting system would cost about $4.5 million to implement, according to the LSC.

The bill’s lead sponsor, Sen. Tim Schaffer, R-Lancaster, said the bill is a means to combat benefits fraud and ensure monies only go to the truly needy.

On Tuesday, food bank operators, the counties’ Ohio Department of Job and Family Services association director, anti-poverty advocates and others urged lawmakers against cutting the social safety net during a still-raging pandemic that has destabilized the economy and increased unemployment rates.

They said more paperwork requirements on top of an already cumbersome application process would cause needy families to slip through the cracks.

“The bill, as it’s currently presented, wants to spend tens of millions of dollars,” said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, to lawmakers.

“It does not provide one additional dime of food assistance.”

SB 17, if passed, would:

  • Impose asset tests on SNAP (often known as food stamps) recipients. They would not qualify for benefits if they have more than $2,250 in cash (a measurement that includes all value of a vehicle above $4,650). The program is currently available to people earning below 130% of the federal poverty line.
  • Impose a new work or education requirement to receive benefits through Medicaid, a federal and state-funded health insurance program that covers costs of care for people who are poor, elderly, disabled or pregnant.
  • Restrict exemptions to the Medicaid work requirement, including raising the minimum age to opt out to 65 from 55.
  • Switch from the current “simplified reporting” system (SNAP recipients need not report small weekly income changes so long as they don’t surpass the eligibility threshold) to “change reporting” (recipients must notify ODJFS of income changes, no matter how small, from things like overtime).
  • Eliminate “broad based categorical eligibility,” which automatically qualifies recipients of one benefit system like SNAP for others like Temporary Assistance for Needy Families.


The bulk of the costs under the bill stem from the $13.1 million needed for information technology to build a new system for a photo ID system on SNAP cards, plus $2 million to issue an estimated 500,000 cards, according to the LSC. The new system would cost $930,000 per year from there.

The state and federal government split the administrative costs of SNAP, while the federal government pays all the program benefits.

Eliminating categorical eligibility would incur a $2.8 million, one-time cost, according to LSC. Eliminating simplified reporting would cost about $1.5 million.

“In addition, these changes will likely pose significant administrative costs for county departments of job and family services, which are responsible for determining SNAP eligibility for applicants,” the analysis states.

In December, about 1.55 million Ohioans received an average $233 in monthly assistance via SNAP, according to ODJFS data, which comes out to about $7.50 per day.


Organizations combatting hunger, homelessness and poverty in Ohio panned the proposal.

“Reducing access to SNAP and Medicaid will harm the health of low-income Ohioans and push even more into homelessness,” said Bill Faith, executive director of the Coalition on Homelessness and Housing in Ohio, in written testimony.

“Ohio simply cannot afford the damage that would be caused by Senate Bill 17.”

Matt Habash, president of the Mid-Ohio Food Collective, said since the pandemic began, more than 56,000 families sought out meals from the collective for their first time.

“The changes to SNAP and Medicaid eligibility in Senate Bill 17 will — without question — increase food insecurity and force more Ohioans to turn to organizations such as ours for the most basic of needs —  food,” he said.

Other groups like the American Cancer Society and the American Heart Association submitted testimony against the bill, as did the Ohio Council of Churches, Equitas Health and more.


Fraud exists within the SNAP system, but there’s little evidence of it occurring at scale.

During the hearing, lead sponsor Sen. Tim Schaffer, R-Lancaster, cited a 2016 report from the Dayton Daily News about $17 million in fraud identified over five years in Butler County. Officials reportedly broke up a SNAP-cards-for-cash operation.

On a statewide level in 2017, ODJFS investigators identified 2,465 instances of fraud worth about $4.5 million — about .2% of the roughly $2.2 billion in benefits administered that year (the most recent with data available).

2015 investigation from the state auditor identified similar, limited instances of fraud within the SNAP program like benefits being claimed from dead recipients. The identified fraud amounted to less than 1 percent of administered benefits and less than the cost of the audit itself.

Several of the bill’s critics questioned why lawmakers are targeting fraud in SNAP or unemployment benefits as opposed to the Pandemic Unemployment Assistance program, a newly created federal program apparently bilked for hundreds of millions by criminal scammers.

The committee did not vote on the bill Wednesday.

This story was originally published by the Ohio Capital Journal and republished here with permission.


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Fewer people will get food, Medicaid, unemployment under Ohio bill requiring more fraud checks, advocates say


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Ohio is one of several states looking to reduce fraud in food stamps and related benefits programs, and Democrats oppose the effort.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Ohio Sen. Tim Schaffer is holding pictures of what he said shows SNAP cards that were found in drug houses. Schaffer is sponsoring a bill that seeks to decrease fraud in Ohio social services, but advocates for the poor say the extra checks and verifications would cut people off services.

COLUMBUS, Ohio – An Ohio Senate bill that seeks to catch fraud among people applying for and receiving social services will result in increased work for county case workers, as well as fewer low-income people obtaining food aid, Medicaid and unemployment benefits, advocates for the poor said Wednesday.

Senate Bill 17 requires case workers to cross-check applicants and enrollees against state data such as new hire records, wage records, lottery winnings and death records, said sponsor Sen. Tim Schaffer, a Lancaster Republican.

Schaffer held up pictures during Wednesday’s Ohio Senate Government Oversight and Reform Committee of food aid debit cards he said were found by investigators in drug houses. He said catching the fraud is important because it’s taking benefits away from those who need it.

Some of the most sweeping changes in SB 17 would be in SNAP, the Supplemental Nutrition Assistance Program.

SB 17 would require color photo identification of at least one adult in every household on Ohio Direction cards, the debit SNAP card.

SNAP recipients would also be subject to more rigorous asset maximums. Generally, a household’s liquid assets would have to fall below $2,250, or $3,500 if the household has an elderly or disabled member. A vehicle could be worth up to $4,650. Such limits do not currently exist in the program.

“If you’re a family in need and you have a car at home which you use to get to work, but you are having a hard time affording groceries for your family, you’ll be forced with the decision: Do you sell your vehicle, which you use to get to work, or do you keep the food from the stomachs of your kids, which is an impossible decision for a parent to make,” testified Kimberly LoVano, the Greater Cleveland Food Bank’s director of advocacy and education, at the committee meeting.

To continue to be eligible for SNAP, households would have to report changes in income within 10 days of learning of the changes, which is not currently required.

LoVano argued that reporting income changes is not reasonable in the cases of people who work in retail or food service. They constantly pick up or lose shifts each month.

“I can tell you fluctuation of one to two shifts a month is the norm, not the exception,” she said.

Other changes in SB 17 would again force Ohio Medicaid to require many recipients of the joint state and federal health care program to work or go to school part-time. Work requirements need federal permission to implement. Ohio Medicaid had received an OK to develop them, but with the pandemic they were delayed. Then President Joe Biden’s administration said it would rescind all state work requirements.

Most of the changes to unemployment would require checking prison records to ensure people who are applying for benefits weren’t recently incarcerated.

Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, told lawmakers her colleagues in other states are fighting the exact same bill. It’s backed by the Foundation for Government Accountability, a conservative-leaning group. Hamler-Fugitt believes the ultimate goal is to weaken social safety net programs.

Sam Adolphsen, a visiting fellow with the Foundation for Government Accountability’s Opportunity Solutions Project, testified to the committee on Feb. 10.

“Senate Bill 17 is a practical and principled bill. It is comprehensive, but it is also a straightforward piece of legislation that establishes best practices and commonsense safeguards,” he said. “The bill is practical because, right now, Ohio faces a serious crisis. The pandemic and shutdown have created havoc for the Ohio economy and state budget. That challenge, made worse by federal changes that bind your hands, has thrown your benefits programs into chaos.”

Hamler-Fugitt, on the other hand, said that SB 17 is overly broad, when the real fraud problem is with pandemic unemployment benefits. Last year, Ohio paid out $330 million in fraudulent claims. Experts say much of that fraud is being perpetrated by sophisticated scammers, often from outside the country.

“Our problem right now is with the unemployment compensation system,” she said. “I’m pleading with you: Do something about where we are hemorrhaging resources now.”

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More than 405,000 Hawaii residents now on Medicaid after record-setting job losses


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Hawaii’s Medicaid enrollment has surged 24% during the pandemic.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


HONOLULU, Hawaii (HawaiiNewsNow) – The number of Hawaii residents on Medicaid, the government’s health insurance program for low-income adults and children, has soared by 24% amid the pandemic as the state saw record-setting job losses.

Ahead of the pandemic, there were 327,199 Hawaii residents on the state’s Medicaid program, Med-Quest. Last week, there were 405,598, a dramatic increase that demonstrates the impact COVID shutdowns and job losses had on workers and their families who lost health insurance, too.

Every county saw a jump in Medicaid recipients.

Honolulu had the most new applications. But percentage wise, Maui saw the biggest increase of 50%.


Increase in Medicaid enrollment since pandemic (Source: None)

Even as the economy has reopened, the numbers continue to climb.

“None of us could have predicted this at the beginning of the pandemic, but the longer it’s gone on and the more we’ve seen families continue to struggle, it’s not unexpected,” said Judy Mohr Peterson, administrator of the State’s Med-Quest Program.

Medicaid is funded using both federal and state dollars. The federal government has increased contributions to keep up and the state is looking to add money to the program, too.


Increase in Medicaid enrollment since pandemic (Source: None)

“We’re in frequent conversations with the legislature and the Governor’s office on the budget situation and ways that we will be able to address the increased needs in the long run,” Peterson said.

To chip away at the budget challenge, a bill that would impose new fees on for-profit health insurance companies is moving through the state Legislature.

But the shortfall could continue if the numbers don’t start to go down soon.


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New York lawmakers, advocates dismayed by Cuomo administration’s proposal to cut Medicaid reimbursements



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NY lawmakers are considering a 1% cut to Medicaid funding.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

A patient wears a protective face mask as she is loaded into an ambulance March 18, 2020, at The Brooklyn Hospital Center emergency room in New York. Anticipating a spike in coronavirus patients, New York City-area hospitals are clearing out beds, setting up new spaces to triage patients and urging people with mild symptoms to consult health professionals by phone or video chat instead of flooding emergency rooms that could be overrun.

John Minchillo / AP photo

(The Center Square) — While the COVID-19 nursing home scandal that has plagued the Cuomo administration drew a lot of attention at Thursday’s legislative budget hearing, New York state lawmakers still had time to pepper administration officials on what’s being proposed for the year ahead. And a proposed 1 percent cut in the Medicaid budget certainly caught the eye of some legislators as well as other advocates.

The Healthcare Association of New York State called on the Legislature to reject the cut, noting that the public insurance program currently only reimburses providers at a rate of 67 cents for every $1 of care given.

“While it is never a good time to cut state support for healthcare, this year it would be devastating. … Further deterioration of that support – especially as we work to end and recover from the pandemic – would worsen an already fragile safety net system and put patients at risk,” Healthcare Association President Bea Grause said in written testimony.

The proposed cut in Medicaid funding comes as the state faces a multibillion dollar deficit it needs to fill. While Gov. Andrew Cuomo has been hopeful the federal government will provide the state with $15 billion in direct funding to make the state whole, he’s noted that program would face cuts without help from Congress.

Lawmakers raised their own concerns, saying the cuts would be particularly hurtful to hospitals that primarily serve lower-income patients.

“If you cut 1 percent of Mount Sinai’s Medicaid allotment and 1 percent of, say, Elmhurst’s Medicaid allotment, that might sound fair to somebody who doesn’t know anything about our hospitals, but it obviously is not,” said state Assemblyman Richard Gottfried, D-Manhattan.

Health Commissioner Dr. Howard Zucker said the administration recognized that hospitals considered part of the state’s safety net were facing challenges even before the pandemic. Once COVID-19 hit and elective surgeries were curtailed, it only became worse.

Deputy Health Commissioner Donna Frescatore told the committee that the 2022 budget contains an additional $900 million for “financially distressed” hospitals.

Still, other lawmakers noted that the pandemic has caused more people to enroll in Medicaid. Senate Finance Committee Chairwoman Liz Krueger, D-Manhattan, pointed out that when the state implemented a cap on Medicaid spending a decade ago there was about 4 million New Yorkers on the program.

She then recalled that Frescatore said earlier in the hearing that number has since grown to 7 million.

“It doesn’t matter how many times we go back and look at the numbers and ask you for the data, you just can’t provide health insurance for 7 million people on a lowered cost from that which you started off on for 4 million people, and you shouldn’t be trying,” the chairwoman said.

Not only were lawmakers upset at the budget cut, but they were also upset that they received information detailing the cuts just the night before the hearing. State Sen. Tom O’Mara, R-Big Flats, said lawmakers had no time to review the plan.

For O’Mara, the ranking Finance Committee member who unsuccessfully tried to get Krueger to swear in Zucker at the beginning of his five-hour testimony, that maneuver is proof that the administration still is not being transparent with lawmakers even in the wake of the nursing home controversy.

“I find virtually everything you’ve said here today to be totally without credibility,” O’Mara told Zucker.


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Health advocates file lawsuit challenging Nebraska’s two-tier system for Medicaid expansion

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The Nebraska Medicaid expansion model includes a feature that provides additional benefits for members who meet wellness efforts and work requirements, and advocates filed a lawsuit to remove those requirements.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

LINCOLN — Health advocates filed a lawsuit Thursday targeting Nebraska’s two-tier system of Medicaid benefits for low-income, working-age adults.

The suit takes aim at what state officials called Heritage Health Adult, under which most Medicaid expansion patients get only a basic tier of benefits.

The state’s plan had been to require that those people meet wellness, personal responsibility and community engagement goals to qualify for dental, vision and over-the-counter medication benefits, which are part of traditional Medicaid coverage.

Nebraska Appleseed attorney Sarah Maresh called the system unlawful because it created “barriers and burdens” for enrollees, in violation of the Medicaid expansion law passed by voters in 2018.


“With coverage beginning last October, community members are ecstatic to finally be able to see a doctor without worrying about receiving a high bill they cannot afford,” she said. “However, we’ve also heard of the frustration and confusion caused by the unnecessary complexities of the tiered benefits system.

“This lawsuit seeks to fully implement the will of Nebraska voters and undo the unlawful actions of the (state Department of Health and Human Services),” Maresh said.

An HHS spokeswoman said the department does not comment on pending litigation.


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Georgia Senator Ben Watson says Biden Administration’s decision to review Medicaid waiver program leaves low-income Georgians in limbo



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GA Senator says Biden’s dismissal of their approved waiver to expand Medicaid coverage for those that work is unfair, and that the argument to suspend the work requirements due to COVID does not make sense for GA, where unemployment is low.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


The following is an excerpt from a recent “The Commute” podcast interview with Georgia State Sen. Ben Watson. “The Commute” is presented by the National Office Systems. Full episodes are available at or through mobile device podcast apps by searching “The Commute with @SavannahOpinion.”

Question: The Biden Administration has rescinded the approval for one of Georgia’s Medicaid waivers meant to provide health care coverage for the lowest-income Georgians. The feds are now reviewing that waiver. Is this a deal breaker? Or something where the details can be worked out?

Ben Watson: “That’s still to be determined. The state of Georgia applied for two waivers, and the one at issue now is the one that covered people from 100% of poverty level down to zero. The other waiver covered those from 100% of poverty level up to 138%. Both were approved last fall by the previous administration, and we were moving forward. What is fundamentally different about the waiver in question and those in every other state is we were proactive in requiring those on the waiver to do 80 hours of service a month. They could volunteer or work part-time or go to technical school or college, so long as they could account for 80 hours a month or 20 hours a week they would be eligible for Medicaid. That was what our thought process was. I still think it’s a good process.”

Question: That work requirement, or service hour requirement, seems to be the sticking point for the Biden Administration. What was your reaction when you heard approval had been pulled and the waiver was in review?

BW: “I was disappointed. We have 30 days to respond and we’ll continue to look at all avenues. From there, the new administration will make a determination. I just hope it is not political, because I think we have a good thing. The governor and his team and the Legislature worked together on this. I think it’s a good system and a good solution, and I think states should be allowed to determine what’s best for their own situations.”

Question: Critics will say the COVID-19 pandemic has made the work requirement untenable because either there aren’t enough jobs or there are people who are apprehensive about working or volunteering or going to school because of the virus. How legitimate is that argument?

BW: “That’s just an excuse. Georgia’s unemployment rate is one of the lowest in the nation right. We’re among the top-five economies in the nation. We’re recovering, and we’ve done better than expected. The cynic in me says, ‘Well, if I’m looking at this program and living in Washington, D.C. or New York City or someplace like that then that might be a realistic discussion.’ But that’s not the case here in Georgia. It doesn’t hold muster. As for the service hours requirement, if people cannot meet that, there are other safety nets for them, such as applying for disability.

“If you believe the government can do better with Medicaid than Georgia can do with these minimum requirements here, I will disagree with you on that one.”


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Bill aims to update Medicaid program

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Arkansas is working to change its Medicaid expansion program to allow those who work to get managed care and those who don’t to be on fee for service.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Arkansas’ version of Medicaid expansion that provides health care coverage for more than 300,000 low-income Arkansans would be called the Arkansas Health and Opportunity program or ARHOME under legislation expected to be filed this week.

The state’s Medicaid expansion program — which was initially authorized as the private option by the Legislature in 2013 — is now called Arkansas Works under Republican Gov. Asa Hutchinson.

The program provides private health insurance coverage for adults earning up to 138% of the federal poverty level, which is $17,774 for a single person and $36,570 for a family of four.

The program’s enrollment totaled 311,511 Arkansans as of Feb. 1, up from about 250,233 on March 1, 2020, before the coronavirus pandemic arrived in Arkansas, according to the state Department of Human Services’ website.

The state work requirement for the program hasn’t been enforced since a federal judge ruled in March 2019 that federal law didn’t allow then-President Donald Trump’s administration to authorize that requirement in Arkansas. That ruling has been appealed to the U.S. Supreme Court. President Joe Biden’s administration last week asked the U.S. Supreme Court to cancel March 29 oral arguments in the case, saying that it has “preliminarily determined” that the work-related requirements would “not promote the objectives of the Medicaid program.”

The state law for the Arkansas Works program and the federal waiver for the program expire Dec. 31.

Hutchinson said Friday that “this new initiative has been developed with the General Assembly and will allow us to continue providing affordable health care in Arkansas and addressing in innovative ways the need for improved maternal health and increasing access to comprehensive care in our rural areas.”

Rep. Michelle Gray, R-Melbourne, said Friday, “I love what we have done with this” new program, which also include targeting certain populations such some veterans, and some of those formerly in foster care.

She noted that in the 2014 election, she campaigned against the state’s Medicaid expansion when it was called the private option.

After serving on the Legislature’s Health Reform Task Force in 2015 and 2016, Gray said she realized the program is needed to keep rural hospitals open.

“Now, I fully support the expansion based on what we have been given by the federal government,” she said. “You have to be pragmatic and govern.”

Gray said she will be the House sponsor of the legislation for the new program that she expects to be filed Monday by Sen. Missy Irvin, R-Mountain View.

Human Services Secretary Cindy Gillespie, Hutchinson, Gray and Irvin will hold a news conference to discuss the legislation at noon Monday at the Capitol, according to the department.

The Medicaid expansion program has deeply divided Republicans over the past several years.

Senate Republican leader Scott Flippo of Mountain Home — who was elected to the Senate in 2014 after defeating one of the legislative architects of the private option program, then-Rep. John Burris, R-Harrison, in a runoff election — said he hasn’t made any firm commitments about the new program.

“It is still an ongoing conversation regarding ARHOME,” he said Friday in an interview.

Flippo said he wants greater accountability features in the new program for things such as improved health care outcomes for its participants.


Human Services Department officials have been working with legislators for several months to design a new program to replace Arkansas Works that slows the growth in state spending, moves people out of poverty through work and education, and addresses some long-standing health issues such as maternal and infant health, said department spokeswoman Amy Webb.

The federal government pays for 90% of the Arkansas Works program and the state pays for the other 10%. The federal government and state’s shares of the cost of programs would continue under the new program, Webb said.

While the new program is designed to slow the growth in state spending for the population enrolled in the program, it also would maintain the economic and fiscal benefits of the Arkansas Works program, Webb said.

“It will do that by requiring the private health plans to meet annual financial targets, by capping payments to health plans at the annual budget neutrality limit in our approved waiver and by holding health plans responsible for full collection of enrollees’ cost-sharing obligations,” she said.

Under the proposed program, people who work and do other activities, such as continue their educations, will have access to the private insurance plans, which provide more timely access than the traditional Medicaid program, Webb said.

“This path allows people to achieve long-term economic independence,” she said in a written statement. “People who do not choose this path will get coverage through the traditional-fee-for-service Medicaid program.” This means it’s not a work requirement, but an incentive, according to Webb.

Webb said no one would lose their health care coverage for failing to meet certain benchmarks under new program.

“What may happen is enrollees who are in qualified health plans may choose not to work, get their education or pursue other activities that help them move toward economic independence. In those cases, they will get traditional Medicaid coverage instead,” she said.

The specifics of how program participants are engaged will be developed over time with the input of the qualified health plans and public and private resources that have experience in working with individuals living below the federal poverty level on taking advantage of employment and education opportunities, Webb said.

The majority of the people enrolled in the Medicaid expansion program are working at least part time, she said.

With the state’s minimum wage now $11 an hour, a single person working full time for the year, or 2,080 hours, would earn $22,880 or 179% of the federal poverty level, Webb noted.

More than 50,000 of the 288,858 people enrolled in the program in October had incomes above 100% of the federal poverty rate, she noted. That’s $12,880 a year. Another 64,000 had incomes between 51% and 100% of the federal poverty level, she said.

“Clearly this group is already ‘engaged’ in moving towards economic independence,” Webb said. More than 108,000 enrollees in October also had a dependent child.

The largest single age cohort of the October enrollees with income below 25% of the federal poverty level were 19-24 years old, and some of these were still working on their educations and others were beginning their employment experience, she said.

Some people in the program will be working to increase their earnings and will be enrolled for less than six months, Webb said. They will have no need of engagement.

“We are developing different engagement opportunities for people in different situations based on age, income level, employment experience, how long they have been enrolled, those at most risk of long-term dependency and family situations,” she said.

Webb said about 84% of the Arkansas Works’ population is enrolled in qualified health plans.

These plans pay hospitals and other medical providers commercial rates, higher than what providers receive for populations enrolled in the traditional fee-for-service Medicaid program, according to a 19-page presentation on the proposed program from the department.

The new ARHOME waiver program would continue to enroll low-income people in the qualified health plans and would bring an estimated $9.76 billion from the federal government into the state’s economy for the next five years, the department estimates.

If Arkansas paid fee-for-service rates instead, the federal government would send an estimated $6.75 billion to the state — a reduction of $3.01 billion over the five-year period — according to the department. That would mean significantly lower payments to hospitals, doctors and other health care professionals, the department said.

If Arkansas paid fee-for-service rates through the ARHOME waiver program, the state would spend $180 million less, the department estimates. But the $3 billion in lost federal revenue would leave the state with $310 million less in state and local tax revenue generated, more than offsetting the reduction in state Medicaid spending, according to the department.

Though enrollment in the Arkansas Works program has increased by more than 60,000, to 311,511, as of Feb. 1 during the pandemic, Webb said that “at some point after the Public Health emergency enrollment will settle back to more historical levels.”

“We will take administrative actions if necessary to keep the [qualified health plans] insurance pool large enough with a population mix to ensure a healthy and stable market,” she said.


The Human Services Department’s Division of Medical Services appropriation, which provides spending authority for the Medicaid expansion program, requires a three-fourths vote, or 75 votes in the 100-member House of Representatives and 27 votes in the 35-member Senate.

That’s often been a difficult threshold to meet over the years. The Medicaid expansion was initially approved by the Legislature in 2013.

In last year’s fiscal session, the Legislature approved an appropriation that granted spending authority for the Medicaid program, which the department projected would spend $9 billion in fiscal 2021 that ends June 30 — $7.1 billion in federal funds and $1.9 billion in state funds.

At that time, the department projected the Arkansas Works program would grow to about 350,000 by August and then decrease by about 2,500 a month from September through June 2021. The department projected the Arkansas Works program would cost $2.27 billion in federal funds and $252.2 million in state funds in fiscal 2021.

The department last week didn’t have cost projections for state and federal funds for the Medicaid program and for the Arkansas Works program for fiscal 2022.

Hutchinson said Friday that a three-fourths vote in the Legislature “is always a challenge, but with early legislative support, I am optimistic that this will pass with sufficient support.”

Sen. Jonathan Dismang, R-Searcy, who was one of the legislative architects of the private option program, said Friday, “We have had that debate before and I’m not sure how it will play out this session.”


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Biden Administration’s Plan to Rescind States’ Medicaid Work Rules Faces Temporary Hitch

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Biden’s effort to unilaterally undo states’ approved work requirements hits a hiccup.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Republican-led states plan to challenge rollback following last-minute Trump administration agreements


The Biden administration wants to roll back some states’ requirements that Medicaid recipients work in exchange for government relief, but its task may be complicated by moves in the final weeks of the previous administration to lock in the requirements for months.

The Republican Trump administration supported work requirements, calling them a way to move people out of the program and into jobs with employer-sponsored health coverage. Typically, a beneficiary has to work 20 or more hours a week, or perform community service or participate in education or job training, in order to get or keep their health insurance.

Democrats say the states’ work requirements run counter to Medicaid’s status as a guaranteed benefit for the low-income and disabled people who qualify for the federal-state health program. Kentucky, Arkansas and Nebraska are among the 12 states that received Trump administration approval to impose work requirements, though some plans were blocked by the courts.

Just weeks before President Biden took office, the Trump administration urged states in a Jan. 4 letter to sign agreements that would preserve work requirements in the program for nine months before they could be undone by the federal government.

The letters say the Centers for Medicare and Medicaid Services, the federal agency that oversees the program, must go beyond offering states a hearing to contest changes, as is typically the case, and instead follow a longer, nine-month process for revoking the arrangements. An HHS spokesman said 17 states signed the agreements, including Georgia, Tennessee and Arkansas.

Republican leaders in the states, having signed those agreements, say work requirements should be binding until September. Some state officials say they are examining whether the agreements signed in January give them legal grounds for challenging the Biden administration’s action


“Arkansas negotiated in good faith with the last administration over nearly a year for its work requirements, which helps lift Arkansans out of poverty,” said Sen. Tom Cotton (R., Ark.).

“President Biden revoked the program without warning,” Mr. Cotton added, “making unilateral decisions for Arkansas voters from D.C. even before fully staffing his administration.”

Mr. Biden recently signed executive orders directing government agencies to re-examine Trump-era healthcare policies, moves that were expected to lead to the unraveling of initiatives such as Medicaid work requirements and short-term health plans. The orders specifically called for agencies to re-examine rules and policies that limit access to healthcare, including pilot programs to alter Medicaid and waivers that let states change the program, such as adding work requirements.

Meanwhile, the Supreme Court may soon weigh in on the issue. Justices are set to consider appeals by Arkansas and New Hampshire over whether the government’s approval of the work arrangements during the Trump administration is legal, following lawsuits by residents of each state. The Biden administration has asked the Supreme Court not to hear the case, and ended the Justice Department’s defense of the requirements that began under the previous administration.

The Biden administration is seeking to withdraw the requirements before the court is set to hear the case this spring. CMS, meanwhile, said in letters to states in February that it wouldn’t uphold agreements made with the Trump administration granting a nine-month reprieve.

Arkansas in 2018 imposed work requirements for seven months, but a lower court struck down the mandate and an appeals court upheld the ruling. Arkansas appealed to the Supreme Court.

Dennis Smith, a senior adviser for Medicaid and Health Care Reform in Arkansas, part of a state agency, said the Biden administration could choose not to approve new work requirements, but revoking a program that was approved by the previous administration and took months of planning was unfair.

“This is really rewriting the relationship between the federal government and states, and everybody has to be really concerned,” Mr. Smith said. “Once you start down that path, where does it stop? States need stability and predictability.”

A spokesman for the Department of Health and Human Services, which includes CMS, said, “Medicaid’s primary objective, as set out by Congress, is to provide medical assistance to serve the health and wellness needs of our nation’s vulnerable and low-income individuals and families—based on need, not based on one’s ability to find work.” He added, “This is not the time to experiment with policies that risk a substantial loss of health coverage or benefits, especially for communities significantly impacted by Covid-19 and other health inequities.”

In Nebraska, ending the work requirements could potentially strip some beneficiaries of certain benefits, state officials said. The state required newly eligible adults to meet certain work and other requirements to get dental and vision coverage that aren’t traditionally covered by the Medicaid program.

Nebraska state officials said the Biden administration should be reviewing Medicaid changes on an individual basis and not reject innovations.

“Nebraska will be making the case for why federal approval of our program should stand,” said Taylor Gage, a spokesman for Republican Nebraska Gov. Pete Ricketts.

Georgia’s program was designed so that lower-income people previously not eligible for Medicaid could get coverage if they met work or related requirements, and state officials said rescinding the approval would deprive coverage to future enrollees. The program has been set to begin July 1, and the state is bound by legislative statute from adopting the Affordable Care Act’s Medicaid expansion. Georgia officials said they plan to argue to maintain their program.

CMS will work with Georgia and Nebraska to explore opportunities for covering the same people, an HHS official said. CMS said it would consider whether the programs promote Medicaid’s objectives before making any decisions.


The new administration’s quick action to start rolling back the agreements is partly a legal maneuver, some legal analysts said, since waiting nine months before revoking them would keep the Supreme Court case alive.

These analysts said the administration would prefer to leave the question of the programs’ legality—and whether Medicaid’s purpose is to provide health insurance or improve the health of its beneficiaries—out of the hands of the Supreme Court.

A decision that defines Medicaid’s purpose solely as providing health coverage could limit the administration’s ability to approve new proposals from states, such as programs that use Medicaid funding to help with housing or transportation, or incentivizing people to participate in wellness programs.

“It would limit the agency’s discretion and could come back to hurt the Biden administration,” said Nicholas Bagley, a health law professor at the University of Michigan.

The Biden administration has asked the Supreme Court to vacate the earlier D.C. Circuit Court of Appeals decision saying the purpose of Medicaid was to provide health insurance.

The administration’s initial steps to end Medicaid work requirements were cheered by advocacy groups and Democrats who say work requirements reduce access to health coverage.

More than 18,000 beneficiaries in Arkansas lost health coverage in the seven months work requirements were in place in 2018, according to state data. Arkansas state officials said the numbers of disenrollment are due to traditional churn in the program, and that other states without work requirements have had higher numbers of people who have been disenrolled.




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Top 4 mistakes Medicaid health plans make when vetting solution vendors

6-minute read

Many of our clients are Medicaid health plan operational teams that manage vendor relationships. The article below is based on our experience working with Medicaid health plans who have been able to optimize their vendor management processes.

Mistake 1: Failing to have a process for managing vendor sales meeting requests

Most Medicaid health plans describe their vendor management scenario as “deluged” with vendor meeting requests. When our plan clients quantify the time they spend on each vendor sales effort, they realize that all the meetings and followup meetings and related correspondence and efforts add up to many hundreds (and sometimes thousands) of health plan staff hours. While some Medicaid plans have begun to implement more policies to manage this process, most plans still have room to optimize the return on this significant time investment.

A defined vendor-engagement process is critical

Mistake 2: Not setting up expectations on the front end for how your vendor engagement process works

Communicate expectations to vendors from the very first meeting

Few vendors (especially new vendors) understand the way your plan prefers to manage procurement efforts. Each plan is different in how it prefers to engage with vendors. Some plans only meet with vendors related to a problem they are actively trying to pursue. Some only meet with vendors they have invited to respond to an RFP. Other plans meet with vendors at any time, to learn more about solutions or to get new ideas.

Once a vendor is engaged in a potential solution discussion, they will need to know what to expect in terms of different business units involved in the decision, information and data that will be needed to support the business case, what to expect in terms of acceptable pricing models and how long the overall process normally takes. Most vendors have no idea what to expect, and most plans do not communicate what to expect. Setting expectations from the start will go a long way to keep everyone aligned and making the best use of your precious time.

Mistake 3: Not right-sizing the proposed project to the problem and the vendor’s current scale

Sometime you need a solution to close HEDIS gaps for 100 members. Sometimes you need an overhaul of an entire process, or a brand new critical technology system. Rest assured, whatever the size of your problem, any solution vendor engaging you in a sales process wants to maximize the size and duration of the contract. If you do not set quantified scope parameters correctly, you will end up with a solution that either doesn’t go far enough or goes too far. Best practices include using a member-level target list (for interventions / gap closure based projects), starting with an initial pilot, and breaking any effort more than 60 days up into phases.

Always fit the size and complexity of the solution to the size and complexity of the problem

Mistake 4: Not checking references in depth

Invest time in longer discussions with vendor references

Vendors pitching you their solution will only show you their very best results. While this information is important, this should not be the only data you use to kick the tires of their capabilities. Ask for more than three references – this way you have a better chance of getting a broad perspective of what other plans have experienced with the vendor.

How You Can Address The Risks of Partnering with Solution Vendors in the Medicaid Space

In addition to your own research into potential vendor partnerd, there are a few key tactics that can help you overcome some of the common challenges in the space.

  1. Engage a consulting firm with deep expertise in the space, but that also has a practice area focused on assisting Medicaid health plans vet solution vendors. We provide this type of assistance to our health plan clients, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.
  2. Consider adding a Medicaid-specific, independent vendor review product to your toolkit. While there are multiple options for vendor reviews in the healthcare space, most are not independent evaluations (they receive their revenues from the vendors reviewed). If you are considering enhancing your vendor review process, an independent review tool is critical.

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What are the 4 critical risks of investing in the Health and Human Services (HHS) space?

6-minute read

Many of our clients are investment professionals working in the health and human services space (including the full spectrum from angel to VC to equity firms). The article below is based on our experience working with investors who have succeeded in this space.

Risk 1: Failing to understand that seeking revenues in the Health and Human Services (space) creates a new set of challenges for your portfolio companies

One of the worst mistakes investors new to the space can make is to assume that strategies rooted in the commercial payer or Medicare Advantage space can be simply pivoted into the Medicaid space. The mistake is understandable, because few portfolio companies understand this risk and they do not know to communicate it to their investment partners.

Risk 2: Underestimating the Learning Curve

Understanding that commercial and Medicare strategies need to be dramatically altered to work in Medicaid is the first step. The next risk is underestimating the learning curve for Medicaid. Each state operates its own Medicaid program, and most benefit, operational and procurement decisions are done independent from federal operations. We have a saying in our space: “If you have seen one Medicaid program, you’ve seen one Medicaid program.” Besides the policy differences across states, each state has its own agency and stakeholder environment, and navigating these is extremely complex for HHS veterans. Finally, the regulatory environment for this space evolves constantly, and in ways that greatly impact revenue projections. For those new to the space, critical mistakes and loss of time are guaranteed.

Risk 3: Miss the Unique Complexity of the HHS Sales Cycle for Your Portfolio Companies

Many investors rely on the relational nature of other verticals for confidence in sales revenues. While relationships play an important role in the HHS space, most contracting is done using a defined competitive procurement process. This applies to both state agency and health plan contracts (though less so in health plans). Because of the regulatory and bureaucratic components, the sales cycle for this space is much longer and much more unpredictable than in other verticals.

Risk 4: Differences in pricing models

The Medicaid space has two key components that drive unique pricing models: A focus on the rate-cell capitation payments to managed care plans, and long-standing efforts to implement value-based payment models.

Medicaid health plans are paid a per member per month (pmpm) fee by states to manage different populations (such as diabatics or pregnant mothers). All the costs for care and management of each member must be funded by those rates or the plan loses money. Each plan thus thinks of all vendor solution costs in terms of pmpm. This type of pricing is not the norm for most portfolio companies operating in the commercial space, and it may take a large effort to structure pricing models in a way that will succeed in the Medicaid space. Most portfolio companies price solutions at an aggregate level and do not have a way to assign costs at the plan member level.

The second challenging part of HHS pricing models is the focus on value-based payments. Most Medicaid state agencies and health plans are required to place an ever-increasing amount of their payments to providers in what is called a “value-based” arrangement. While precise definitions of these models remain elusive, the critical risk is not being able to clearly tie a portfolio company solution to specific member outcomes. Vendors should also be prepared with standard risk sharing arrangements to offer to prospects in the Medicaid space.

How You Can Address The Risks of Investing in the HHS Space

In addition to your own research into this vertical, there are a few key tactics that can help you overcome some of the common challenges in the space.

  1. Engage a consulting firm with deep expertise in the space, but that also has a practice area focused on assisting investment professionals. We provide this type of assistance to our investment clients, and are happy to have a conversation anytime. If our services and expertise are a fit for your needs as you develop or execute your strategy, engaging with us is a simple process. If we are not the right fit, we are happy to make a referral to another firm who may be.
  2. Consider adding a vertical-specific market intelligence product to your toolkit. While there are multiple options for general investing market intelligence in the healthcare space, if you are considering (or already executing) an investment thesis tied to HHS-vertical revenues, the more specific your research sources, the better.

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