State Marketplace Profiles: Arkansas
As of October 29, 2013
Establishing the Marketplace
On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance Marketplace (also referred to as exchange).1 A state opting for a partnership Marketplace can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations or use federal government services. Arkansas planned for a Partnership Marketplace while the legislature worked to authorize State-based Marketplace legislation.
On April 23, 2013, Governor Beebe signed HB 1508 which authorizes the transition of the Marketplace from a state-federal Partnership Marketplace to a State-based Marketplace to take effect on July 1, 2015.2 In July 2013, Arkansas announced the name of the Marketplace would be Arkansas Health Connector.
Structure: The legislation defines the Marketplace as a “non-profit legal entity” not affiliated with the state government.
Governance: The Marketplace will be governed by an 11-member Board of Directors. The Board of Directors includes two ex officio members (or their designees): the Insurance Commissioner and the Director of the Department of Human Services. The Governor appoints three members, including one representative of brokers and two consumer representatives. The President Pro-Tempore of the Senate appoints three members, including a representative of health Insurers and one representative of small employers. The Speaker of the House also appoints three members, including a representative of health insurers and a representative of a health-related profession.3
Current appointed Board Members are:
- Sherrill Wise, Dillard’s Inc., Interim Chairman
- Steve Faris, Lottery Commissioner
- Chris Parker, Eichenbaum, Lilies P.A.
- Fred Bean, Bean Hamilton Corporate Benefits
- Mike Castleberry, HealthScopes Benefits
- Greg Hatcher, Hatcher Agency
- John Denery, Stephens Insurance
- Annabelle Imber Tuck, Public Service Fellow and Jurist-in-Residence at UALR Bowen School of Law
- Jerry Jones, Arkansas Department of Health
The Arkansas Health Insurance Marketplace Board held its first meeting on September 3, 2013 and launched a website in November 2013.
Contracting with Plans: In early 2012, the Insurance Department issued a Request for Proposals (RFPs) for subcontractors to assist with the development of Exchange requirements related to qualified health plan certification.4 The state has since created a Plan Management Advisory Committee comprised of dozens of stakeholders representing hospitals, insurers, businesses, and consumers.5 The Committee meets bi-monthly and focuses on the definition and delivery of Qualified Health Plan guidelines. Recommendations from the Advisory Committee are forwarded for approval to the Steering Committee, and then sent to the Insurance Commissioner for approval. In September 2012, the Commissioner approved recommendations that Arkansas not require network adequacy standards that exceed the federal requirements in the first year, that carriers not be required to offer qualified health plans statewide, and that the state may limit the number of plans or benefit designs offered by a carrier.6
On May 23, 2013, the Arkansas Insurance Department (AID) issued guidelines for QHP issuers planning to offer coverage in the state’s Partnership Marketplace describing network adequacy, rating, service areas, EHBs, cost sharing, and the private option.7 The guidance also included requirements for implementation of the Health Care Independence Act of 2013, which requires enrollment of those newly eligible for the Medicaid expansion, except those deemed medically frail, into QHPs through the Marketplace. It specifies that all QHPs must offer a Zero Cost Sharing Silver Plan for those with incomes up to 100% of the federal poverty level and a High-Value Silver Plan with standardized cost-sharing for those with incomes 101-138% of the poverty level.8 On September 23, 2013, AID released QHP rates for the Marketplace, featuring 71 QHPs from four carriers.9
Consumer Assistance and Outreach: Various consumer assistance and outreach activities are facilitated by the Arkansas Insurance Department and through subcontractors. The state has created a Consumer Assistance Advisory Committee comprised of dozens of stakeholders representing consumers, hospitals, and community organizations.10 The Committee meets bi-monthly and focuses on developing guidelines for the In-Person Assister (IPA) program, which will operate alongside federally-funded Navigators in the state, outreach efforts, and consumer complaint resolution. Since May 2012, the Advisory Committee has issued numerous recommendations regarding IPAs including that brokers and producers be allowed to serve as IPAs, that IPAs complete a state training for certification with certain defined competencies, and that the state pay IPA entities using a combination of a contract payment and performance-based payment.1112
AID released a Request for Qualifications for IPA Guide entities in April 2013 and in June 2013, awarded contracts to 26 organizations to hire more than 500 IPAs.13 In addition, AID released a question and answer document for Guide organizations addressing concerns surrounding hiring, training, licensure, reporting and other operations guidelines.14 Because Arkansas is now transitioning to a state-based marketplace in 2015, the legislature authorized the Arkansas Health Insurance Marketplace Navigator, Guide, and Certified Application Counselors Act to inform the responsibilities, qualifications, and licensure standards of these now state-based consumer assistors.15 On September 24, 2013, AID released the Health Connector License Application, which individuals must use to become an IPA, navigator, certified application counselor, or licensed insurance producer.16 Current Insurance Brokers and Agents must also use this Application to be licensed to sell insurance in the Marketplace.
Arkansas launched its Marketplace website, ARHealthConnector.org, on July 1, 2013. The Health Connector website provides information on rates, insurance plans, eligibility, and contact information for Guide Organizations. The Arkansas Insurance Department awarded a $4.3 million outreach and education contract to promote the AR Health Connector Marketplace to Mangan Holcomb Partners on April 1, 2013.1718 Beginning with the launch of the website, other campaign activity includes statewide television, newspaper, billboard, gas pump, Internet, radio, and bus advertisements.19
Coordination with Medicaid: Arkansas has developed a Private Option to integrate their Medicaid program expansion with the federally-facilitated exchange. The Department of Human Services (DHS), which includes the state’s Medicaid agency and multiple other agencies, determined the state will use the “Access Arkansas” portal as an Exchange interface.20 Arkansas received approval from the Centers for Medicare and Medicaid Services (CMS) for enhanced funding to upgrade its Medicaid eligibility and enrollment systems. On September 27, 2013, Arkansas received CMS approval for a Section 1115 waiver to pursue a three-year “Medicaid premium assistance demonstration” (Private Option).21 Individuals with incomes between 100% and 138% of the Federal Poverty Level (FPL) and parents with incomes between 17% and 138% FPL who qualify for Medicaid will be able to purchase a qualified health plan through the exchange using premium assistance subsidies.22
Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Arkansas Insurance Department accepted Rule 103, which granted EHB-decision-making authority to the Insurance Commissioner.23 Based on analyses and stakeholder feedback, the Arkansas Exchange sent preliminary EHB recommendations to the Commissioner for review which were accepted. Preliminary recommendations included the small group plan Arkansas Blue Cross Blue Shield Health Advantage Point of Service Plan as the benchmark. Also, the state chose QualChoice Federal Plan Mental Health and Substance Abuse Benefits to meet the federal mental health parity requirement, the Arkansas Children’s Health Insurance Plan (CHIP) for pediatric dental services, and the Arkansas Blue Cross Blue Shield Federal Pediatric Vision Plan for pediatric vision coverage.24
Financing: By October 1, 2014, the Arkansas Health Insurance Marketplace is required to develop recommendations for the initial assessment or user fee that will be needed to support the Marketplace operations and must recommend increases or decreases in the amount of future assessments or user fees, by October 1 of each subsequent year. These recommendations will require approval by the Arkansas Health Insurance Marketplace Legislative Oversight Committee and the Arkansas General Assembly.25
The Arkansas Insurance Department received a federal Exchange Planning grant of almost $1 million in 2010. In September 2011, Governor Beebe contemplated applying for a Level One Establishment grant but declined after hearing lawmakers’ objections.26 A few months later however, the state submitted an application for $7.6 million in federal funding to implement the partnership exchange.27 In February 2012, the grant was awarded and Arkansas planned to use the funds to design and implement IT systems to connect Arkansas Medicaid and state-run exchange functions to the federally-operated eligibility and enrollment portal, implement systems to support state-operated consumer assistance functions, and develop plan management functions of the Exchange. In September 2012, Arkansas received a second Level One Establishment grant of $18.6 million to work in partnership with the federal government and other state stakeholders to implement plan management and consumer assistance components of the Exchange. In April 2013, Arkansas received a third Level One Establishment grant of $16.5 million to fund the IPA Guide program, provide oversight and coordination for Federal Navigators working in Arkansas, implement an outreach and education campaign, develop an Arkansas Health Connector Resource Center, and update QHP certification and monitoring criteria.28 In October 2013, Arkansas received a fourth Level One Establishment grant of $10.6 million to continue supporting the state’s role in consumer assistance and plan management functions. The Board of the Arkansas Health Connector will apply for additional federal funding by November 15, 2013 to support the transition of to a fully State-based Marketplace.
On January 3, 2013, Arkansas received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-federal Partnership Marketplace. Enrollment in the Marketplace began October 1, 2013.
Governor Beebe Letter to Secretary Sebelius. December 12, 2012.
Arkansas State Legislature. Act 1500 “The Arkansas Health Insurance Marketplace Act”. April 23, 2013.
Lyon, John. “Health Insurance Marketplace Board Holds First Meeting.” September 3, 2013.
Request for Proposals. Quality Health Plan Specialist. Arkansas Insurance Department. January 30, 2012.
Arkansas Federally-facilitated Exchange Partnership. September 17, 2012.
Arkansas Insurance Department. “Requirements for Qualified Health Plan Certification in the Arkansas Federally-Facilitated Partnership Exchange (Marketplace).” May 23, 2013.
Arkansas Insurance Department, “Requirements for Qualified Health Plan Certification int eh Arkansas Federally –Facilitated Partnership Exchange (Marketplace), Bulletin No. 3A-2013," May 23, 2013.
Arkansas Insurance Department. “Qualified Health Plan Individual Premium Rates.” September 23, 2013.
Consumer Assistance Advisory Committee IPA Entity Application. August 10, 2012.
Arkansas Insurance Department. Hiring Contracts for Guide Organizations. 2013.
Arkansas Health Connector. Questions and Answers for Guide Organization. June 28, 2013.
Arkansas State Legislature. Act 1439-- Arkansas Health Insurance Marketplace Navigator, Guide, and Certified Application Counselors Act. April 22, 2013.
Arkansas Insurance Department. Arkansas Health Connector Licensing. September 24, 2013.
Arkansas Insurance Department. Request for Proposal. March 1, 2013.
Arkansas Insurance Department. Anticipation to Award. April 1, 2013.
Arkansas Insurance Department and Arkansas Health Connector Division. Updates for House and Senate Public Health, Welfare, and Labor Committees. July 25, 2013.
Department of Health and Human Services. Letter to Mr. Andy Allison, Director of Arkansas Department of Human Services. September 27, 2013.
Arkansas Insurance Department. Plan Management Questions & Answers #1. June 21, 2013.
Commissioner Jay Bradford, Insurance Commissioner. Rule 103: Essential Health Benefit Benchmark Plan. Arkansas Insurance Department, June 28, 2012.
Arkansas Insurance Department. Selection of Arkansas’ Essential Health Benefits Benchmark Plan. September 21, 2012.
Arkansas State Legislature. Act 1500 “The Arkansas Health Insurance Marketplace Act”. April 23, 2013.
DeMillo A. “Ark. Insurance Officials Look at Health Exchange.” Forbes. October 11, 2011.