NHeLP Comments to Arkansas 1115 Demonstration Application

Executive Summary

These are comments to Arkansas’ section 1115 demonstration application (filed August 8, 2013) to implement a Medicaid Expansion using a premium assistance model. NHeLP’s comments identify a number of legal problems which HHS must require Arkansas to correct prior to approving the demonstration.

Centers for Medicare & Medicaid Services Department of Health and Human Services
P.O. Box 8016
Baltimore, MD 21244-8016
Re: Arkansas Health Care Independence Program (?Private Option?) Demonstration
Dear Sir/Madam:
The National Health Law Program (NHeLP) is a public interest law firm working to advance access to quality health care and protect the legal rights of low-income and underserved people. We appreciate the opportunity to provide comments to Arkansas? proposed Health Care Independence Program § 1115 demonstration.
NHeLP recommends that HHS not approve the Arkansas request for section 1115 authority to conduct premium assistance, exactly as requested. Instead, first, we urge HHS to address a number of concerns in the proposal and encourage Arkansas to bring it to a legally approvable form. We urge HHS to work with Arkansas to achieve a Medicaid Expansion that will serve future Medicaid enrollees well, including those inside Arkansas benefiting from this proposal and those in other states who may pursue similar proposals.
Second, we ask that before HHS takes action on this waiver request, it take steps to address its own ?stewardship of federal Medicaid resources.? GAO, Medicaid Demonstration Waivers: Approval Process Raises Cost Concerns and Lack of Transparency at 32 (June 2013). As the GAO recently concluded, ?HHS?s [budget neutrality] policy is not reflected in its actual practices and, contrary to sound management practices, is not adequately documented?.[T]he policy and processes lack transparency regarding criteria.? Id. We request that HHS zealously enforce its stated policies and the legal limits of Medicaid section 1115 demonstration law, to ensure progress in Arkansas without opening the door to policies that ignore the fundamental nature of Medicaid as an entitlement program.
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