Medicaid Expansion Through Premium Assistance: Arkansas, Iowa, and Pennsylvania’s Proposals Compared
Arkansas, Iowa, and Pennsylvania have proposed implementing the Affordable Care Act’s (ACA’s) Medicaid expansion by using Medicaid funds as premium assistance to purchase coverage for some or all newly eligible Medicaid beneficiaries in Marketplace (formerly called Exchange) Qualified Health Plans (QHPs). Arkansas and Iowa’s § 1115 demonstration waivers have been approved by the Centers for Medicare and Medicaid Services (CMS), and Pennsylvania’s application has been released for public comment.1 These states seek demonstration waiver authority primarily because they propose to make premium assistance enrollment mandatory for affected beneficiaries.2 Iowa and Pennsylvania also propose to waive their obligation to provide wrap-around benefits and to impose premiums not otherwise allowable under federal law; Pennsylvania additionally proposes to require beneficiaries to participate in job search activities. Iowa will cover newly eligible adults with income below 100% FPL through another waiver involving Medicaid managed care, and Pennsylvania’s waiver proposal includes some provisions that affect populations currently eligible for Medicaid coverage. This fact sheet compares the states’ proposals. Key similarities and differences between the proposals are summarized in Table 1 below and further details are included in Table 2.
Arkansas Health Care Independence Program (Private Option), CMS Special Terms and Conditions (Sept. 27, 13), available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-private-option-ca.pdf; see also Arkansas Medicaid, Health Care Independence (a/k/a Private Options) § 1115 Waiver – FINAL (Aug. 2, 2013), available at https://www.medicaid.state.ar.us/general/comment/demowaivers.aspx; Iowa Marketplace Choice Plan, CMS Special Terms and Conditions (Jan. 1, 2014-Dec. 31, 2016).; see also Iowa Dep’t of Human Servs., Iowa Marketplace Choice Plan § 1115 Waiver Application (Aug. 2013), available at http://www.dhs.state.ia.us/uploads/IAMktplaceChoice1115_Final.pdf; Pennsylvania Dep’t of Public Welfare, Draft Healthy Pennsylvania 1115 Demonstration Application (Dec. 2013), available at http://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/document/p_039654.pdf.
For background about the state plan option and demonstration waiver premium assistance authorities and key beneficiary protections in Medicaid expansion premium assistance program, see Kaiser Commission on Medicaid and the Uninsured, Medicaid Expansion Through Marketplace Premium Assistance (Sept. 2013), available at http://www.kff.org/medicaid/fact-sheet/medicaid-expansion-through-marketplace-premium-assistance/.
also of interest
- Medicaid Expansion Through Marketplace Premium Assistance
- Premium Assistance in Medicaid and CHIP: An Overview of Current Options and Implications of the Affordable Care Act
- Medicaid Expansion through Premium Assistance: Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal