Success in the Arkansas legislature will "allow other states to evaluate what they're going to do on the expansion, including states like Ohio,” said Edwin Park, vice president for health policy at the liberal Center on Budget and Policy Priorities.
State legislators have discussed similar ideas in Florida and Texas. And Marilyn Tavenner, acting administrator of CMS, said last week that her agency is in discussions with “a handful” of other states about using approaches similar to Arkansas to expand their programs.
The Arkansas plan also was notable for spurring the CMS to issue some of the rare guidance it has provided states looking for flexibility (PDF) to meet the provisions of the reform law and still garner the support of more conservative legislators. Those details—issued March 29—may help other Republican-led states looking to use a similar approach, Park said.
Despite the CMS' strong interest in the Arkansas approach, Tavenner emphasized to senators at her April 9 confirmation hearing that the CMS has yet to approve any aspect of Arkansas' plan.
Federal regulators are expected to look closely at the plan, said Denise Rodriguez, a healthcare attorney at Foley & Lardner. “The question will be whether it's cost-effective,” Rodrigues said.
Cost effectiveness is a CMS requirement. Estimates from the state concluded that Arkansas' approach, compared to a standard expansion of the state's Medicaid program, carried a relatively small cost for Arkansas taxpayers and would reduce federal costs. However, policy experts are uncertain whether CMS officials will consider other financial and coverage details in their own cost analysis.