The Performance Evaluation and Expenditure Review (PEER) joint subcommittee met earlier today, with a good chunk of attention devoted to the outreach workers that will be hired as part of the Affordable Care Act, known as “guides.” One thing is clear: Republican lawmakers opposed to the ACA are going to raise a fuss about the guides every chance they get.

*THE PRIVATE OPTION GUIDES: PEER reviewed the $4 million appropriation for the 100 additional guides that will be hired for the “private option.” DHS Director of County Operations Joni Jones testified that per the latest Center for Medicare and Medicaid (CMS) guidance, the state will be responsible for a 50 percent match (or $2 million). It was originally thought that all of the guides would be fully federally funded. However, this development will not require any additional state expenditures, because of a separate piece of news from CMS: administrative activities related to enrollment and eligibility for the expansion population will get a 75-25 federal match instead of 50-50 as expected. Savings from that change will be used to pay for the needed match on the guides.


*THE ELEPHANT IN THE ROOM: Planned Parenthood came up briefly (see here and here for the background) but because the Arkansas Insurance Department has delayed their contract, this battle will be fought another day. But it clearly will be a battle. Here’s one question: if Republican lawmakers get their way and the state refuses to give a contract to Planned Parenthood, will the state open itself up to a lawsuit? Can the state legally refuse, for political reasons, to grant a contract to one entity that meets all of the necessary qualifications? Keep in mind that Insurance Commissioner Jay Bradford plans to “define…a clear scope of work,” with the group, suggesting that Planned Parenthood will have an entirely different contract from every other entity.

*TRAINING: Exchange Director Cynthia Crone testified that guides will get 30 hours of state training, 20 hours of federal training, and a third phase of training focused on the private option (hours not yet determined). In response to the request of Sen. Jane English, Crone said they would be able to make the training curriculum available to the public this summer.


*CONFIDENTIALITY Rep. David Meeks expressed concerns about privacy. Crone said that guides will not keep private information and will be bound by HIPAA. She said that one of the training modules will be entirely on confidentiality.

“How are you going to make sure they’re going to follow the guidelines you have actually set out?” Meeks asked. “How are you going to make sure that this information doesn’t, you know, whatever?”


“We will do background checks, we will do training,” Crone said. “The persons will be licensed by the Department of Insurance and monitored in that way. If there’s any complaint, it will be investigated like it would be for any licensed insurance person. If they have done a breach of confidentiality — which we don’t expect and will do everything to protect against — they will lose their license.” Crone added that there will be three contract monitors charged with watching over the guides.

*MEEKS LEARNS TO LOVE GOVERNMENT AGENTS: “I have a problem with any non-state-entity doing this,” he said. He suggested that a guide provided by a not-for-profit might collect names and addresses of the people they were assisting for a database to send fundraising letters.

*DEPARTMENT OF WTF: Meeks was also very concerned about whether the servers for the web portal would be in-state.

Meeks: “Where are these servers, these computers, located that will be passing the information back and forth?”
Crone: “The information will be with the federal health insurance market place.”
Meeks: “Do we know what state?”
Crone: “I can’t say for sure if their server is in Washington DC or where. I could ask that question for you.”
Meeks: “Yeah, if you don’t mind I would like to get some more information about…”
Crone: “The physical location?”
Meeks: “The computer location, the servers.”


Bring on the black helicopters.