1. EXPANDING MEDICAID THROUGH WAIVERS: THE ARKANSAS “PRIVATE OPTION” Anna Strong, Health Policy Director Arkansas Advocates for Children and Families astrong@aradvocates.org 501-371-9678 ext. 119

2. Arkansas’s Private Option: Overview  Acts 1497 and 1498 of 2013  Use Medicaid funds to purchase private health insurance for most new eligibles through AR’s Partnership Marketplace  “High-level” silver plans only  Medicaid protections - wraparound  Budget Neutrality  Attestation that coverage is “not an entitlement”  Sunsets June 30, 2017, but waiver ends December 2016  Exchange considerations - flexibility

3. How did we get here?  Needed a majority vote for the enabling legislation for an expansionBUT… Need an annual “super majority” vote for the appropriation of funds 75 of 100 votes in the House 27 of 35 votes in the Senate

4. How did we get here? Takeaways:  Balancing consumer needs with political reality  Drawing a line in the sand  Strong coalition and the right messengers

5. Consumer Concerns  Children’s coverage  Benefits (EPSDT, Transportation, Family Planning, Community Health Centers, Prescriptions)  Cost-Sharing  Access to care  Eligibility/Enrollment  Accountability, transparency, consumer protection  Budget Neutrality

6. Consumer Representation  During session: publications, coalitions and advocacy  1115 Waiver Public Comments by AACF  Consumer/Partner Brief  Comments on AR Department of Human Services draft  Federal comments to HHS on final  State Plan Amendments  Medically Frail questionnaire, other details

7. Consumer Concerns Takeaways:  Make your voice heard at the state and federal level  Help partners be engaged

8. Future Changes to Private Option  KIDS!  Parents <17% FPL!  Health Savings Accounts!  Cost-sharing 50-100%  Non-emergency Transportation  Waiver amendment transparency

9. Future Changes to Private Option Takeaways:  Transparency for future waiver amendments is not guaranteed – but request it!  Precedent – we want what other states got

10. Heading Toward Success?  Wins  SNAP-Facilitated Outreach – 65,000 adults, 3,000 kids  Marketplace pool is younger, much bigger  Challenges  Re-appropriating funding for Private Option  Enrollment system  Outreach/Education funding

11. Thanks!  Anna Strong, Director of Health Policy  astrong@aradvocates.org astrong@aradvocates.org  501-371-9678 ext. 119