A bill filed by Rep. Andy Mayberry (R-Hensley) would fulfill Governor Hutchinson’s plan to use proceeds from the state’s tobacco settlement to reduce the waiting list of families seeking a waiver to obtain home/community-based services for children with developmental disabilities.
In September, the governor announced his intention to use tobacco settlement funds to substantially reduce the 3,000-person waiting list. Some families have been waiting eight or nine years to receive home-based services, such as respite care and home health aides. At the time, Hutchinson proposed ending a now-obsolete program previously funded by the tobacco settlement and steering its $8.5 million budget towards reducing the waitlist. Since the money would pull in federal funds at 70-30 matching rate, that would result in about $29 million more for waiver services, potentially covering 500 to 900 people. That would be great news for families like the Dodsons, whom I wrote about in a 2014 story for this paper.
But hold on. There’s one new wrinkle now that didn’t exist in September: Donald Trump is about to be president.
The program Hutchinson proposed defunding was a limited health coverage benefit called AR Health Networks, which was available to a small number of Arkansans in the days before the Affordable Care Act. The program was rendered obsolete by the passage of the private option (aka Arkansas Works), which was created through Obamacare’s Medicaid expansion and made quality, subsidized insurance available to almost all the state’s low-income citizens. (Confusingly, the initiative created by the Tobacco Settlements Proceeds Act of 2000, such as AR Health Networks, is also referred to in statute as “the Medicaid Expansion Program,” but whenever we use the phrase “Medicaid expansion,” we’re referring to the expansion under the ACA.)
With the election of Trump, the ACA’s days are likely numbered. U.S. Rep. Tom Price, Trump’s pick for federal Health and Human Services secretary, wants to end the the Medicaid expansion altogether. Hutchinson, a conservative governor presiding over a state benefiting mightily from Obamacare, wants the Medicaid expansion to stay. No one knows what Trump will do, or Congress, but the point is that the continuation of the private option revenue stream is much, much more uncertain than it was before Nov. 8. In other words: As limited and paltry as the old AR Health Networks was, it won’t seem quite as obsolete if the private option disappears.
And even if the Medicaid expansion is one of the pieces of Obamacare that gets preserved, pre-expansion Medicaid will likely see a net decrease in funding if Republicans succeed in instituting block grants.
That doesn’t mean the legislature shouldn’t pass Mayberry’s bill. Absolutely none of this changes the moral imperative of addressing the developmentally disability waiting list as soon as possible, and since the governor has committed to using the tobacco settlement money for this purpose, it almost certainly will come to pass. But still, this is a reminder that the health budget flexibility afforded by the windfall Obamacare created for the state may soon disappear.
And as for further reductions to that developmental disability waiting list, which will still have around 2,000 people on it after the tobacco money is applied? Don’t expect that to happen anytime soon if private option funding is killed, or if Congress slashes Medicaid funding in general.