Gov. Beebe: partial expansion idea not dead yet

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Gov. Mike Beebe told reporters today that the new rules on co-pays released by the feds on Monday “indicated some willingness to grant some flexibility.”

The new rules are relatively small potatoes (see below), but co-pays have been one idea that Republican lawmakers have suggested might be part of a deal to go forward with Medicaid expansion. But the big one remains the notion of “partial expansion” — establishing a lower eligibility threshold for Medicaid expansion than 138 percent of the federal poverty level, the line established by the Affordable Care Act.

The feds have been explicit that it’s all or nothing — if Arkansas and other states want the generous matching rates that come with the ACA, they have to expand the Medicaid program to cover folks making up to 138 percent of the FPL. But Republican leaders are holding out hopes that there may yet be wiggle room.

Beebe said that his administration is in “constant communication” with the feds on Medicaid issues.

As to the idea of partial expansion, he said, “it’s way too early to know. That they were willing to embrace co-pays…is an indication that they are not as rigid as they once were, or as many people thought they were. Whether that goes beyond co-pays remains to be seen.” Beebe said there were tentative plans to meet with federal officials to discuss expansion when the National Governors Association meets in Washington in February.

As for those new co-pay rules, they may serve as helpful cover for Republicans seeking a compromise position on the expansion question, though it's hard to believe they will do much to raise revenue. Under the revised rules, states could charge a maximum co-pay of $4 for outpatient services used by beneficiaries below the federal poverty line, up from the current limit, which is between $1.30 and $3.90 depending on the service; and they could charge an $8 co-pay for non-preferred drugs and non-emergency uses of emergency rooms for folks at or below 150 percent of the FPL.

Matt DeCample, Beebe’s spokesman, said, “The governor is supportive of having co-pays as part of the conversation. We’ll see what specific ideas for Arkansas arise in the coming weeks.”

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