The plan's 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 the CMS, said this month 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 spurred the CMS to issue some rare guidance for states looking for flexibility 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 do something similar, Park said.
Despite the CMS' apparent inclination to go along with the approach in Arkansas and elsewhere to reach its coverage goals, Tavenner emphasized to senators during her April 9 confirmation hearing that the agency has yet to approve anything.
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,” she said.
The CMS said it will require that states given waivers to cover Medicaid enrollees in the insurance exchanges must show their approach is cost effective. Arkansas officials estimated that its private-option plan, compared with 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 analysis.
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