In a July 19 letter to the Arkansas Department of Human Services, Bishop Anthony B. Taylor said a current proposal by the department threatens health care access to members of the population who can least afford it.
“A wholesale change in the manner in which health care is delivered to the poor in this state without testing the changes under actual conditions will likely destroy a system that presently functions, greatly reducing the availability of health care to the poor, especially in rural areas,” he wrote.
At the heart of the bishop’s comments is a proposed change in the manner in which federally qualified health centers (FQHC) and rural health centers (RHC) are compensated for the medical services they provide. The proposal by the DHS would allow the state to limit reimbursement to health centers to the amount negotiated with a qualified health provider carrier.
Such an arrangement would likely lower the level of reimbursement to the health centers in the name of cost savings, which in turn impacts centers’ ability to operate, particularly in rural areas. It particularly complicates reimbursement for treatment of recent, legal immigrants who are ineligible for Medicaid and for undocumented Arkansans who are ineligible for any state or federally subsidized care, waivers or insurance.
“Rural health centers provide holistic medical services to the poor in Arkansas, operating in many areas as the only provider,” Bishop Taylor wrote. “They not only serve those eligible for government-sponsored care, but also those without any coverage whatsoever, such as many in the immigrant community. They serve their patients well under the current prospective payment system.
“Until there is empirical data based on rigorous study to prove otherwise, wholesale replacements of the prospective payment system endangers the very existence of rural health centers,” he continued. “The delivery of health care to the poor people…of rural Arkansas is thereby threatened.”
The state health department submitted the proposal as part of a larger application for waiver necessary to implement the Healthcare Independence Act of 2013. Passed in the waning hours of the Arkansas General Assembly in May as a compromise to expanding Medicaid coverage to an additional 250,000 low-income Arkansans, the law instead uses Medicaid dollars to buy individual insurance policies for eligible individuals. Federal approval is required to use the Medicaid funds in this manner, prompting the state department’s 30-page draft waiver.
Bishop Taylor supported Medicaid expansion heading into the General Assembly and praised passage of the Healthcare Independence Act as an acceptable, if flawed compromise, saying at the time, “it was far better than doing nothing, which was the only other option on the table.”
In his July 19 letter, the bishop also cast doubt on health department officials’ claims that reduction in reimbursement would be offset by the forthcoming insurance system because a wider segment of the population would have coverage.
“A realistic assessment is that a greater percentage of those eligible will not enroll and it remains to be seen how negotiations between individual insurers and the individual rural health centers will develop,” Bishop Taylor wrote.
Patrick Gallaher, executive director of Catholic Charities of Arkansas, echoed the bishop’s sentiments, citing low response rates to Deferred Action for Childhood Arrivals, a program that enabled teenage and young adult children of undocumented immigrants to gain a two-year reprieve from deportation and work or attend school legally. That program attracted an estimated 50-percent application rate among those eligible in Arkansas and of the estimated 1.5 million eligible nationwide, only 500,000 have as yet applied.
“The thinking that presumes all who are eligible will enroll in a process so complex the government is hiring waves of people just to help with enrollment is simply not realistic,” Gallaher said.
The draft waiver’s public comment window closed July 24, with the final version of the waiver application expected to be submitted Aug. 2. Gallaher said the change in the compensatory structure was not part of the Healthcare Independence Act language, nor is it necessary to align with the Affordable Care Act. In fact, given that the reimbursement structure was constructed at the federal level, any state guideline that arbitrarily deviates from it is ripe for legal challenge, he predicted.
Through his letter, Bishop Taylor also took the opportunity to again voice objection over the inclusion of coverage for sterilization, abortion and contraception as “essential health benefits.” While the Arkansas legislature opted out of funding abortion on demand through the state insurance exchange, as allowed by the Affordable Care Act, abortion services are covered in cases of rape, incest or in the interest of the mother’s health. Abortion on demand will also be covered by insurance plans through the Arkansas exchange by purchasing a separate rider.
