*UPDATE: The Arkansas legislation took shape today with this extensive amendment, including some new Republican sponsors.
While lawmakers will clamor for further assurances and details from the feds, the information released in recent days has affirmed the basic framework of the Arkansas “private option” (although you might not have known it reading some responses in the national media).
The most substantive release from the feds came Friday, a short FAQ pertaining to “private option”-style premium assistance, released last Friday by the Centers for Medicaid and Medicare Services (CMS). Rep. John Burris stated on Twitter that “the document helps” but questions remain. “No bad news,” he tweeted. “Just reminded me of how I want our questions answered.” That was followed up today by a letter directly to the state from Kathleen Sebelius, Secretary of Health and Human Services, which gave broad approval to the Arkansas framework (a little too broad for Republicans, and negotiations on that front will continue).
But in terms of the policy, the CMS memo reasserts what we already knew about the “private option” approach. Arkansas would use Medicaid dollars to cover the full premiums of private health insurance on the exchange for the expansion pool. Recipients would have the same cost-sharing, benefits, and “wraparound” coverage protections that they would under traditional expansion (under 100 percent of the federal poverty level would be governed by the updated ACA Medicaid rules; for the 100-138 group, protections would be equivalent to the same group on the exchange). These protections of coverage and cost-sharing were always part of the “private option” deal — as we have reported numerous times and is confirmed by emails from administration officials when the announcement was first made — though there was apparently some confusion about this outside of the state.