December 29, 2017

LITTLE ROCK – Many challenges facing state government in 2018 will have a familiar ring, but will take on a modern twist.

A good example is Medicaid. The state administers the health care program for people with disabilities, the elderly and low-income families, and since it was created in the mid 1960s state watchdogs have been working to improve efficiency and accountability.

The Department of Human Service administers Medicaid, and the department plans to introduce an innovation in 2018 to control costs for home care and personal care, which in Arkansas run about $800 million a year. The department will contract with a software firm to will operate a cloud-based “electronic visit verification” method to reduce fraud. The new system will use technology available on smart phones.

About 15 other states are doing something similar to hold down costs in their home care programs. The idea is to make sure that personal care workers have actually visited the homes of Medicaid patients when they file claims for reimbursement.

Home care and personal care workers are paid to visit Medicaid patients to help with household needs like personal hygiene and preparing meals. After the new verification system is in place, the smart phone of the home care worker will record and transmit a log of its location and the times it was at particular locations. Computers can verify that the phone has actually been at the home of the Medicaid patient, and for how long.

The system will work even if the home is out of cell phone range, because modern phones have clocks and GPS that continue to work even when the device is not in range of a cell tower. After the worker gets back within cell phone range, a record of the visit will be transmitted to monitors.

After difficulties implementing a new computer system, the department has a digital verification system in place that in 2017 removed about 80,000 Medicaid recipients from the rolls. For example, the department now checks a recipient’s income by accessing files at other agencies. It also checks whether an Arkansas recipient is receiving Medicaid benefits from another state.

State officials expect other changes in the Medicaid program in 2018, when they learn from federal agencies whether proposed reforms for Arkansas Works will be approved. Arkansas Works is the expanded Medicaid program that Arkansas implemented after passage of the federal Affordable Care Act.

The state administers Medicaid, but because the federal government provides the vast majority of its funding, changes in eligibility or level of service in Arkansas Works must first be approved by the federal government.

The department has asked for approval of a plan to reduce eligibility from 138 percent of the federal poverty level to 100 percent. Also, the state wants to add a requirement that some recipients work, look for work or take job training in order to qualify for Medicaid.

When the legislature convenes in a fiscal session in February, one of the most important bills to consider will be the appropriation that authorizes Medicaid funding. Passage of the funding measure will require a 75 percent majority in each chamber of the legislature.