ALC - Hospital, Medicaid, - Developmental Disabilities Study Subcommittee
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- October 4, 2026
Representative Mary Bentley
Unverified
2:00
If everybody get to their seats, we're about to get this committee started.
all right we'll call this subcommittee meeting to order thank you all for coming out in a hot summer day i hope everybody's having
a good summer your air conditioning units are working well at home things are going well we have a lot a lot of hot things to talk about as this committee moves forward when we get done with these discussions we'll go over our timelines because it's very important for us to understand where we are in our timeline to get the reports that we need to get ready for 2027 so we'll go over that timeline when we get done we're going to start this morning
with secretary man and mary franklin to come and talk to us about work requirements and some things that are going on with medicaid so if they'll come up front here we'll get get started i'm sure everybody will have lots of questions thank you all for being here today i'm going to uh jump jump
here in just a second we've got a lot a lot of things that we discussed
and we need a lot of wisdom uh representative beck would you lead us in just a moment of prayer
before we get started and i can't get up
Speaker 9
3:47
and representative uh english camp but the rest of y'all will. Thank you. Amen. Thank you, Representative Beck. Okay. If you guys will
Representative Mary Bentley
Unverified
4:02
recognize yourselves we're ready to begin thank you good
Speaker 13
4:10
good morning mary franklin um dhs division of county operations all
Speaker 13
4:22
you today about community engagement and work requiring requirement that is coming to the our home mary could you move that speaker just a a little bit
Representative Mary Bentley
Unverified
4:31
mic a little bit closer to you thank you very much is that better okay uh good
Speaker 13
4:37
morning we're uh we're here today to talk about community engagement and work requirement that is coming to
the medicaid program um it is it will impact the our home eligibility group which are individuals aged 19 to 64 um this community engagement and work requirement it will be in compliance with the 2025 federal budget bill that was passed in July of 25 we did a soft launch we're in a soft launch right now we started on July 1 and what soft launch means is that we are using the data
we have available now in our system and sending them notifications of where they would stand with the requirement so we're doing all normal business
Speaker 20
5:22
but we're giving additional information about this requirement is coming and here is where you would stand if this requirement was in place today The full community engagement and work requirement rules, they will be implemented January 1 of 27.
Speaker 13
5:37
So the Our Home Cases, another change that's coming along with work requirement change
is that the renewal cycle for Our Home Cases will change from a 12-month cycle to a 6-month cycle. And that will impact all of the R-Home beneficiaries with the exception of American Indian and Alaskan Natives. They are accepted out of that six-month cycle and will remain in a 12-month cycle. And if they don't meet any exception or exemption in the month of application, then a one-month look-back period will be used.
And the same rules are going to apply for work and community engagement when someone requests retroactive
Speaker 20
6:23
coverage. Retroactive coverage in our home is already 30 days prior to application or the month before. And that we already had in place with our waiver here in Arkansas, but it is changing federally for any of the adult expansion populations to 30 days. So if they request
Speaker 13
6:44
retro, we'll be looking, if they're not exempt in the retro month,
we'll be looking at the month before to see if they had compliance. There are compliance and exemptions are also called
Speaker 20
6:58
exclusions and exceptions by CMS. Just wanted to call that out, and they'll be verified
Speaker 13
7:06
at both application and renewal. Next, we're going to talk about specified excluded individuals. Some individuals in our home will not be subject to community engagement and work requirements, and CMS calls these individuals specified excluded individuals.
They won't be subject to that look-back period at application or renewal, and we must verify that they continue to be a specified excluded individual. And here in this chart, we're calling out specific information about who these specified excluded individuals are. They include Indian, Californian Indian, urban Indian, and Alaskan Natives. Parents and caretakers of children age 13 or younger.
or those who are taking care of a disabled individual at any age, participating in compliant with SNAP or TANF, those are specified excluded individuals, inmates of a public institution or a former inmate for up to three months after their release date, pregnant women or those in their postpartum coverage period, former foster care youth under age 26, and then individuals with special medical needs, including those who are disabled, physical, mental, intellectual, or developmentally disabled
that significantly impair their ability to complete community engagement activities. Participating in a drug or alcohol rehab program or other serious or complex medical conditions. Those we have been talking about as exemptions, and I'm just pointing out that CMS calls them specified excluded individuals, but these are the exemptions from community engagement. there are also exceptions to community engagement so there are some additional
exceptions for those who are not specified excluded individuals and so there are still some exceptions that someone can meet and if someone meets an exception they don't have to demonstrate that compliance in that one month look back period so the exceptions include those who are under age 19, those who are entitled to or enrolled in Medicare Part A or B, or the specified excluded individuals are also accepted from that look-back period, and those who have a
short-term hardship, and a short-term hardship is being defined or it includes those receiving inpatient or institutional care, and they request the exception, those who have to travel outside of their community for medical care for themselves or for a dependent and they request the exception. Those who live in a county with a federal emergency or disaster declaration and we will establish this based on information about the federal disaster declarations or those living
in a county with a high local unemployment rate and that is if Arkansas requests the exception and the U.S. Health and Human Services Secretary approves such an exception. Next, I want to talk a little bit more about disability and special medical needs. An individual with a disability that's established by Social Security Administration qualifies as a specified excluded individual. An individual with a VA rating of 100% will also be a specified excluded individual.
Medical providers will be able to complete a form regarding the individual's disability for those who are not established as disabled by Social Security or VA. Individual's provider can also complete some information and let us know that this person should be an excluded individual and that they're unable to do community engagement activities. But we are also going to use claims data, diagnosis and claims data from our MMIS system to try and establish that ex parte but this other option will be available to individuals who may
need that and think they should be exempted from the requirement. Now if you are not a specified excluded individual then that means you're an applicable individual and that means that the requirement applies to you and we need to use that look back period to see if you were compliant or exempt in the month before application or at renewal that you have been compliant or
met an exception during one of those months during the renewal period. So compliance with requirements. An individual meets the requirement if they work at least 80
Speaker 20
11:57
hours a month or they earn or have income the equivalent of federal minimum wage and right now that
Speaker 13
12:08
equivalent that monthly equivalent equals $580 a month so if they are not working or have income that is at least
equivalent to minimum wage for 80 hours a month then they must complete 80 hours of community service or participate in a work program for 80 hours or be enrolled in an educational program at least have time or they can engage in any combination of those activities to meet that compliance requirement. Also want to seasonal workers those who maybe don't work all the time but they work if they if their income is averaged over six months would meet that 80 hour requirement
then they will also be considered compliant. So I'm going to run through some examples just to help help maybe clarify what all that means, particularly about the income and the $580 a month. This is something that CMS has clarified that if the MAGI household has income that totals 580 or more, then that household is considered compliant. Even if there's more than one adult in the household, even if only one of the adults has the income, even if the income isn't earned
income. If they have countable income in the MAGI household that's $580 a month, then that household is considered compliant. So here's an example. Example one, Mary and Chris are in the same MAGI household and Mary earns $580 a month. Both of them are compliant. An example two, Mary and Chris are in the same household. Mary earns $300 per month and Chris receives $300 per month unemployment benefits for a total household income of $600. They're both compliant because
that total household income is more than $580 a month. In example three, Mary and Chris are in the same household. Mary earns $100 a month. Chris earns $300 a month for the total of $400 a month. neither one, neither are compliant, and Mary, with her $100, has 14 hours towards that 80-hour-a-month requirement, and Chris has 41 hours, so just wanted to share those examples to help clarify
income. Some additional information I want to share with you about the community-engaged requirement part-time students so if they are not at least half-time considered half-time by their higher education institution then we're going to calculate their compliance with the part-time hours
Speaker 20
14:48
by multiplying their credit hours by three and then multiplying that by 4.333 that's because there's a little bit more than four weeks in general
Speaker 13
15:00
and every month to give them credit for
that so if they're taking one class for three credit hours then that class will get them 12.99 but we're going to round up to 13 that'll give them 13 hours of compliance that they can put with other activities including earnings including volunteering community service or another work program so if if it's a if it's a school that doesn't do credit hours then we're going to count class
Speaker 20
15:31
time hours or educational activity hours on a weekly basis to calculate that monthly number
Speaker 13
15:37
of hours toward compliance and I also want to give you some nuances related to the caretaker exception the care a caretaker of a person the exclusion for being a caretaker of a person of any age who is disabled they don't have to be related if they live in the same household if the caregiver and recipient of care are related then they don't have to live in the same household so if they don't live together and they're not related they must do 80 hours of care for that
exclusion for that to meet the requirement otherwise the number of hours of care they provide can go with other things to make them compliant so there there are some special things related to the caregiver exclusion
Representative Mary Bentley
Unverified
16:27
we've got a few questions then we'll then we'll finish up Mary Frank okay thank you we're going to start with
Senator Jane English
Unverified
16:36
a senator English hey thank you can you go back to the examples here just a minute sure so I'm a little confused so we're saying that people have to have be working in order to get Medicaid unless they're
one of these exempt groups I'm a little confused about the $300 and Chris receives $300 unemployment is that just a basic minimum or what people can't live on that I mean is that and so if they're working obviously hopefully they're making more than $580 a month I don't I don't understand what we're doing with people
Speaker 20
17:20
here? Well, the law said that basically CMS has said if they are earning the
equivalent of 80 hours a month minimum wage based on the federal minimum wage, which I believe is $7.25 an hour, if you multiply that by 80, that's $580 a month. So that's the requirement they have to meet. Here in Arkansas, our minimum wage is $11 an hour. So they won't have to work 80 hours to meet that compliance level they have to earn 580 dollars oh that's all they have to earn yeah they have to earn 580 dollars and in addition to that cms has the law says based on the magi
household's income if their income is 580 dollars and income can be more than earnings it can be other things that we have to count if they have income of 580 dollars a month then that household is
Senator Jane English
Unverified
18:18
meeting the requirement. So then going to the part-time students and all that, so if it's for credit hours or some of the non-credit courses, are they the same, treated the same?
Speaker 20
18:32
So the credit hours, we multiply by three and then multiply that again by 4.33 to get monthly. But if
Senator Jane English
Unverified
18:41
they're in a short-term training program like at UALR, or Plaski Tech or whatever, how do you do that? Because those aren't for credit. Right. Well,
Speaker 20
18:50
those we would count class time hours. And sometimes you're in class all day, right, five days a week for those types of training. It's just going to depend on class time and educational hour, how many hours does that total.
And then we would multiply that by
Senator Jane English
Unverified
19:08
the same factor. So then I guess probably my biggest question is how do we get these people to these things so that they have the opportunity to better
Speaker 13
19:19
themselves. How are we doing that? So one of the things we are going to do, and that's
Speaker 20
19:25
on my actually last slide of information, we are working on implementing a contract. We have already done the procurement and evaluation. We've done anticipation to award, and there were no protests.
Speaker 13
19:36
That contract is currently being reviewed by CMS and FNS, and we plan to bring it to you, we hope, next month. we
Speaker 20
19:44
hope next month and we will have this contract implemented and it is for a customer service center in general so that we can do better telephone and virtual customer assistance to those who try to contact us but
Speaker 13
19:59
a big piece of this customer service center is going to be this outbound verification center where after we have checked all our data sources made the determination that
we can make and we give this individual 30 days to show us how they have met these rules either been exempt or compliant
Speaker 20
20:19
this outbound verification center is also going to start attempting to contact them using text using email using outbound telephone engagement and then when they reach those people they will be trying to help them if they need to be connected to like workforce services or workforce connections or if they they have other needs part of this call center will
also be a closed loop referral system that if someone says I need help with this this referral
Speaker 43
20:46
system can make that referral and then give us feedback on what the outcome of that referral was so
Representative Mary Bentley
Unverified
20:57
is service delivery okay representative Eves thank you just a
Representative Les D. Eaves
Unverified
21:03
quick question uh the number do you have the number or percentage of um folks who are right now covered under our home who
Speaker 13
21:16
so i looked before uh this meeting this morning just to check the our home enrollment it was between 215 and 216 000 i did not specifically look to see how many of those are in snap but it's typically a very high
Representative Les D. Eaves
Unverified
21:32
percentage and those people if they're receiving snap or tanif are excluded or exempt from the work requirement
Representative Les D. Eaves
Unverified
21:42
of folks that are receiving those benefits is over half of the our home population it it's it's a pretty high
Representative Ryan A. Rose
Unverified
21:52
percentage. Yes, sir. Thanks. Representative Rose here. Thank you, Director Franklin. Thank you for your presentation. Thank you for taking the time. You mentioned when it came to the part-time student requirements that there are maybe potential options if the student isn't receiving credit if it's some kind of a program or studies that don't offer credit hours is there a specific
listing of what could count as being a student or studies that are not specific credit hour type settings so i'm i think if it a
Speaker 13
22:40
lot of higher education is based on credit hours but i think There
Speaker 26
22:45
are certification-type classes that are not based on credit hours. I really don't want to misspeak.
Speaker 13
22:53
I don't know exactly what those are, but I suspect it might be something like welding,
where you are working towards a certification but not necessarily
Speaker 26
23:03
earning credit hours. And so the class time, while you're working on that welding certification, those
Representative Ryan A. Rose
Unverified
23:15
meeting that requirement. And that's where I would be interested in the specific requirements, primarily for the reason there are numerous beneficial classes that are offered. I'm thinking of like parenting classes and workshops that are available through major hospital networks, nonprofits, court-appointed programs.
And if there's parents that are in a three-month or a 12-month kind of like cohort of parenting classes, I'm curious if that would count. There may be organizations that would benefit from that, as would the parents who are trying to navigate
this process. I'm not necessarily suggesting we change rules, but I'm interested in what
Speaker 13
23:57
would qualify. Yes, sir. And, you know, I'm on the same page with you, and we will base it on any CMS guidance along those lines about the types of education that count.
But right now, my understanding of that, it's pretty broad as long as it's education, then it would count. And we would need to be able to verify it, of course. I'd be interested if
Representative Ryan A. Rose
Unverified
24:20
we could get just what those requirements are, because I think there's a lot of groups out there who would be mutually beneficial for what their mission is for our Kansans and making sure that everybody could be in compliance with that. Thanks for the latitude, Madam Chair. You're welcome. Thank you. Representative Allen? Thank you, Madam Chairman.
Representative Fred Allen
Unverified
24:39
My question to you is do you all have the manpower to keep up with
Speaker 13
24:48
the new requirements? So we We will be using ex parte and that will help there will be additional workload of course This is a new requirement and the renewal cycle is going from 12 months to six months. So There, there is going to be more work coming our way, but we also do still have a contractor that helps us with eligibility support that we will rely on as we need to, to help get Medicaid applications and Medicaid work completed through this process.
Representative Fred Allen
Unverified
25:20
I understand that, but my question is, do you all have the
manpower to keep up with the new requirements? If not, it's going to be obvious that it's going to be challenging and difficult for some of the people, and many of them will fall within the cracks.
Speaker 74
25:43
Yes, sir. Thank you for the question. I'll just expand on Director Franklin's answer. we are we are monitoring the manpower yes there are going to be more duties we we do recognize
that we are also looking at what can within our systems have more automation to help with that and then part of the reason of doing the soft lies soft launch go live is for training within our divisions and county offices in addition to education to the beneficiaries so we are monitoring it and I don't know that we will have a complete answer until we finish a cycle when we go when we do the live with with
the adverse actions starting in January one last follow-up
Representative Fred Allen
Unverified
26:32
how you are going to disseminate the information out there so the recipient will know what the new requirements are so we we
Speaker 20
26:44
we've sent notices to the entire our home group we did that early July to let them know about the requirement and to let them know where they stand with the requirement based on the information we have now
we have also done follow-up emails
Speaker 13
27:02
and texts our Medicaid customer service vendor is is doing the same thing follow-up emails and texts we have been using social media to help push out the messaging and our comms team has also created a special web page called ar.gov slash engage where we keep information updated on that requirement we did a series of five in-person town halls
Speaker 20
27:26
over the last several months and we will continue to do things like keep our information updated
Speaker 64
27:36
continue to reach out to clients, and then this outbound verification center that will be coming online very soon will also help to make sure beneficiaries know and understand their
Representative Denise Garner
Unverified
27:49
requirement. Thank you. Representative Garner. Thank you, Madam Chair. I've got a couple of questions, two very specific ones, or one very specific one about multiple diagnoses, but patients who are being treated for cancers or getting cancer treatments every day or those folks who are in renal failure and getting dialysis every day,
are you saying that if a physician gives you that information that that will put them into that group that is eligible? So
Speaker 13
28:21
we do have clinicians at DHS working on figuring out those diagnoses and accompanying claims codes that would indicate someone has a special medical need that would make it difficult for them to do the community engagement activity. So that is going on, and we will use MMIS to the extent that
we can based on those diagnoses and claims information to determine people exempt without having to make them do anything, provide anything, or verify anything. In addition to that, those who are 100 disabled through the va or those who are receiving disability through social security administration those will also be considered exempt and we'll we'll check for those things ex parte without the client having to do anything but in addition to that because individual circumstances can vary and um the if we determine through our ex parte sources that we
don't see that this person meets an exemption for that reason they will have an optional form that they can take to their medical provider and if their medical provider agrees that they are not able to do community engagement due
Speaker 26
29:32
to their medical condition that provider can complete that form and send it back to us will you
Representative Denise Garner
Unverified
29:41
give us a list of those things as soon as you those diagnoses as soon as you have them or those medical codes can we get that information please yes and my second question is um that you've talked about um contract customer service center
eligibility support medicaid services contractor outbound verification is that one contract or is that several contracts and if so how much is all that costing and i'm not talking about y'all y'all going out to town halls or anything like that but just the contracts how
Speaker 13
30:14
much are the contracts costing um the eligibility surge support contract is separate from the community service contract and we'll have to get you those specific numbers i don't want to misquote anything so basically
there's yes they're they're both well we already have a medicaid call center contract in place we already have eligibility surge support in place okay we will just be uh bringing a new contract for customer service center that
Speaker 26
30:40
will replace the existing one to you guys so we're essentially already spending this money on both of those contracts okay great i just left to know the three and and we're not
Representative Denise Garner
Unverified
30:53
adding services or adding cost to any of those they're doing
they're doing the same thing they would be doing anyway or they're just adding those services to
Speaker 13
31:05
the contract without adding we're getting additional services in the customer service center it will include some virtual capabilities for to help clients and with with self-service and it will include this outbound verification center and it will also include the closed loop referral system that we don't have now but I do believe that the new contract is actually going
to be able to come to you at
Speaker 20
31:31
a savings over the existing okay I just don't have the numbers great
Representative Aaron Pilkington
Unverified
31:41
Hilton you're next thank you chair um on page four on the exclude individuals there's pregnant women are those in their postpartum coverage how long is that postpartum coverage is that six weeks or 12 months it's 60 days
two months two months okay is that the same in every other state no
Speaker 13
32:01
I do belong the postpartum period is different
and I actually need to I would need to clarify the CMS rule around that to know whether community engagement is based on the state's postpartum period or a specific period of time so
Representative Aaron Pilkington
Unverified
32:15
if it is based on individual states every other state that implemented these rules would be at 12 months but arkansas would be at 60 days is that my correct understanding of your statement if
Speaker 13
32:29
that is what i need to confirm that with the cms guidance if the guidance is based on state's
Speaker 64
32:35
postpartum period versus an established postpartum period in the community engagement requirement i just don't know that answer but i
Senator Justin Boyd
Unverified
32:50
will get it for you yeah i appreciate that thank you representative senator boyd thank you madam chair just a clarifying question so the way i am understanding this is if you're entitled to or enrolled in medicare part a or enrolled in medicare part b that's an exception so if you're entitled to or you're enrolled in
medicare then you don't have to meet the work requirement so question number is that correct That is correct, and
Speaker 80
33:16
actually that person would be moved out of the Our Home category because if you have Medicare eligibility, you're not eligible
Speaker 64
33:22
for Our Home. So if we discover someone has Medicare, it moves them out of the category. You answered my real question,
Senator Justin Boyd
Unverified
33:28
is why would they be in Our Home? Thank you. Thank you. I'm going to jump
Representative Mary Bentley
Unverified
33:34
in here before I take the next question. So going back to the postpartum period, if we know that parents or caretakers of a child age 13 or younger are exempt,
I don't understand. I mean, they have a new baby, so they're going to be exempt anyway. The child is under 13, so I'm not, I'm curious the quandary there. It's going to be, I mean, the child, they have a child that's under 13, so they're going to be exempt
Representative Mary Bentley
Unverified
33:57
in the home under 13. Right, so if they've given birth to a new baby, they're going to be exempt for 13 years, actually. Most likely. Yeah, okay. Just jumping back there.
Representative Rick Beck
Unverified
34:08
Okay, Representative Beck. Thank you, Madam Chair. I'm just going to drill down a little bit on this, the education exemption.
So how are you guys keeping track? Is it like the institution going to fill out a form that says, I'm doing this many hours a week? Or is that where it would
Speaker 13
34:32
hope not. That would be a possibility. But we are working on an interface with the National Student Clearinghouse. And further, we are also working with the state data hub team to see what we can get of this ex parte.
Speaker 26
34:48
But that being said, when we do those ex parte checks, if we don't find that someone's a student and the information that's available, they will get a 30-day notice saying, we need to know how you're meeting or compliant from this requirement. And if they have that information, they can provide it at that time. But we are going to try to get it
Representative Rick Beck
Unverified
35:08
through data sources. So is that classroom, at times I'm being in the classroom, or is that just what I was scheduled to be in the classroom? You know, I might not show up for classes.
Speaker 13
35:19
So we'll be verifying that they meet student status, like they are enrolled in 12 college hours or whatever that
Speaker 26
35:26
number might be. But there isn't going to be like a weekly or a monthly reporting requirement to show they attended class. Basically, if they are enrolled, that is how we're going to do the verification. All right.
Representative Rick Beck
Unverified
35:43
So is that the rules that were handed down?
Speaker 13
35:48
So the requirement is that you have to meet it at application
and at renewal during the look-back period. In
Speaker 26
35:54
Arkansas, we are planning a one-month look-back period, at least as we start this work requirement, Because it's a big
Speaker 64
36:01
change for all of us, for the clients, and for all of us working in this requirement. And then we can go from there to look at increasing it, if we need to increase it. All right. Thank you. Thank you. Representative Ennick?
Representative Denise Jones Ennett
Unverified
36:33
Thank you, Chairwoman. I have a question, Ms. Franklin. I'm sorry I was late to this conversation. You might have already mentioned it. On page six, disability and special medical needs, is there an appeal process to this or a correction action piece to this? So anytime we take an
Representative Denise Jones Ennett
Unverified
37:03
is it clearly stated how they can do that?
Speaker 80
37:07
Yes. All of our notices have appeal rights on them and how to file an
Representative Denise Jones Ennett
Unverified
37:12
appeal instructions. Okay. I have one more question. Also, does this interact with the CES waiver or the passes in any way? No, ma'am. Okay. Thank
Representative Stephen Meeks
Unverified
37:30
you. You're welcome. Representative Meeks? Right here in front. Thank you. So one of my colleagues, just to trigger curiosity,
I just actually got back from the largest AI conference in North America, 13,000 people, 100 different countries, hundreds of AI vendors.
Looking forward to sharing with my colleagues some of the stuff I learned. But one of the things that stuck out to me is one of the presenters who's in government said that if government is not properly using AI, they're doing a disservice not only to their employees but to their citizens. Um, you know, talking about, about the, about the workload, are you all, where are you at with trying to employ AI to help us with some of these issues that the ultimate goal for our state employees is they need to know that the AI is not there to take their jobs.
And the best possible world is the AI will do a lot of computer work so the people can deal with the people, can be there to interface with the people and help the people. So it frees up our employees to try to take a lot of burden off of them to free them up so they can actually work with the clients and not spend so much time working on computers. So I'm just curious where you're at with implementing any of these technologies in your department to try to help with some of these workload issues.
Speaker 13
38:53
Absolutely. Thank you for the question. We have started using AI. The first thing we used AI for was in our newborn category. We have a bot that helps process newborn applications. It reads the document, and if it can, approves the document. If it can't approve the coverage, then we create a task for the worker, and the worker
Speaker 26
39:18
takes it from there and gets the newborn covered. We are going to soon implement a voice agent
Speaker 64
39:26
that goes along with that bot
that's reading the document and filling in the blanks in our system, and the voice agent will attempt to contact the household if there are
Speaker 26
39:38
missing blanks, missing information we need, to additionally help the worker, but again, if a worker needs to look at it, then it'll go to a
Speaker 13
39:47
worker to look at, so that is the first thing we did. We have also recently implemented a bot to help us with National Directory of New Hire Tasks. National Directory of New Hire Service is something
we are required to participate in for the SNAP program, but it quarterly brings a lot of tasks, So it takes a lot of focus, you know, every quarter. And the bot is helping us process those tasks so we can free workers up for other things that we need workers to do. We just, in the last couple weeks, launched a returned mail bot, which looks at all the returned mail and processes it if it can. And otherwise, it goes to a worker to look at. By October, we will have implemented or we plan to have implemented our first generative AI tool, which will be something to help with SNAP accuracy in particular.
Speaker 55
40:41
It's called Case IQ, but it is providing real-time feedback to a worker as they are getting ready to authorize a
Speaker 13
40:50
case to point out things that can be error-prone. Like, for example, this case you have entered more expenses than you have entered income for this household. So you need to address that, you know, document why this is correct or go back and correct either the expenses or the income. That's just one example of the things that would be brought to a worker's attention that they will have to address before they can move forward with approval on that.
We have also gotten a grant from FNS to help us with a summer EBT bot to help us do very similar things for
Speaker 64
41:22
summer EBT that the newborn bot is doing for newborn. And I was going to say, we have also gotten a grant to help us with some fraud detection, but I don't know that it includes AI. But we will continue to move forward with AI for use cases that make sense for us.
And I will point out that this customer service center, one of the requirements we had in the
Speaker 13
41:50
RFP is you need to bring AI to the table to help make this efficient and, you know, make it fast and make it friendly. And, you know, one of our points was we do not want to use AI to keep people from talking to an employee if that's what they need. But we want the AI to help do as much as it can for the person so they don't have to wait to talk to a person.
Speaker 20
42:12
But the goal is not to block access, but only to make the process better and more efficient.
Representative Stephen Meeks
Unverified
42:18
I'm glad to hear you say that. So it sounds like overall it's been a very positive experience moving forward. I love the
idea of one of my concerns is that we don't want to create digital walls where people can't get in touch with people. The whole point to the AI should be to free up our people so they can talk to other people. Yes. So, and it sounds like you're heading in that direction. We definitely will have the human in the loop. Excellent. That's what we want to see. All right. Thank you. Thank you, Representative Meeks. Representative Hudson.
Representative Ashley Hudson
Unverified
42:49
Thank you, Madam Chair, and thank you all for being here. I want to kind of go to the other end of the spectrum, away from the high-tech to the low-tech. I heard you talking earlier about some of the tasks that the contractors do with regard to sending emails, texts, having available information on the website and things of that nature. We know from our original rollout back in 2018 that we lost a disproportionate number of beneficiaries who did not have Internet access. And so I wondered what we were doing to ensure that those beneficiaries in the state who don't have internet access are also getting timely updates about their status and getting those touches to make sure that they have the opportunity to provide additional information as needed, especially given the fact that for those that are working, eight to five may not be a good time to reach them.
So what efforts are being made on the low end part of
Speaker 118
43:45
the scale? So one of the lessons learned from the last work requirement
Speaker 26
43:50
was moving away from that monthly reporting requirement. So this new requirement does not require monthly reporting. It is at application and at renewal. And a lot more ex parte effort going into trying to establish whether a person is meeting or exempt from this requirement before we ever ask the worker to do anything.
But if we need to ask the worker or the client, I'm sorry, if we need to ask the client to do something, they get a 30-day notice. Even at application, if we can't establish that they're exempt or that they were compliant the month before with our data, then they're going to get 30 days to provide that information to us. They can provide that information in person at an office. They can mail it. They can email it. They can log it into their account at Access Arkansas. And, in fact, our notices now where we request information have a QR code on them that they can even scan
and then upload pictures from their phone without even having an account at
Speaker 13
44:51
Access Arkansas. And then we'll also have this outbound call center who's attempting to call, email, text, you know, those things as well. so all of those things will be in place and and are actually in place today with the exception of that outbound verification center where clients can communicate
Speaker 64
45:08
with us in multiple ways and provide information in multiple ways okay representative eaves so just a real quick
Representative Les D. Eaves
Unverified
45:21
question on the school credit hours a minute ago you said that you would multiply the credit hours by three and then you said if you're taking one three-hour course you would just multiply that by 4.33 but the slide says you multiply the credit hours by three so would you multiply that three and then by 4.3 let me double check my math on
Representative Stetson Painter
Unverified
45:54
us whenever you can. Okay, Representative Painter. Thank you, Madam Chair. Representative Ease took my question, but my second question is sparked off of Representative Garner's questions. You know me in contracts. Where is that call center out of? Is that here in arkansas or is that it is okay thank you okay
Representative Denise Jones Ennett
Unverified
46:29
representative ennett thank you madam chair i
have one more question um once um a person is um under the specified excluded individual category um is there a regular check-in do they have to re uh establish this their client not claim but Do they have to re-up it every so often? Is there a schedule there? So if
Speaker 80
46:56
in the month they apply, we determine they're a specified excluded individual, they're exempt.
We don't have to look back at the previous month to see if they would have been compliant. Same as at renewal. So at renewal, if they are exempt, when we initiate their renewal, then we don't have to do that one month look back. They're exempt from the requirement, and if they are otherwise eligible, the eligibility would continue. So we're going to be looking at application and at renewal. Okay, thank
Representative Mary Bentley
Unverified
47:29
you. Okay, I've got a couple of questions. So we're going back to SNAP and TANF.
So we are doing a work requirement for SNAP as well, right? So some of those individuals are going to be having a work requirement regardless because
SNAP is having a work requirement, correct? Yes. So how are we, can you go over what the current caseload is? How many case workers do you guys currently have? What's their caseload we're looking at right now? I know you guys have different groups, like some groups are eligibility and some are case managers. So just kind of give us a load, a breakdown, you know. I don't know what that's looking like.
Speaker 80
48:08
to be specific. We do integrated eligibility, which means our caseworkers, they learn and handle all the programs. The only specialized work that we have related to work requirement would be in the TANF program where our case managers, that's their focus. They do case management for our T and WorkPays clients. They may also do updates to the eligibility cases just for their clients that they're working with, but they don't in general do general eligibility and other things.
But we do integrated eligibility, so the workers are flexible, and if the client has Medicaid and SNAP or
Speaker 64
48:44
Medicaid SNAP and T, they do it all. All right. So the subcommittees, we're looking at workforce,
Representative Mary Bentley
Unverified
48:49
right, and getting folks to work as a very positive thing, not just for financially, but for mental health for our folks, for their self-esteem and for families to move ahead and get out of crisis and to get them a good. And the whole purpose is not just to be punitive and to do hateful things. We want people to get to work because work is a good thing and a good thing for our families to get out of poverty.
So are there some things that you guys think that we can do locally in your DHS offices or places where we can actually connect people to current opportunities, be that education, that be current work opportunities? I know in Perry County, our local two-year college in Moralton is doing some amazing things that in nine months those people can get a great job. But if they don't know about it, they don't know about the training, then we're kind of, and I know you guys have a lot going on, but I would love us to look at the opportunity that we can to use your employees to be also helping them to connect good things to this population to where we can connect them to workforce in a simple and seamless way
so we can actually get families moving forward. Because, again, that's the whole purpose, not to be spiteful, but to get families out of poverty and into you know the whole thing was about being a hand up and not a handout to get people out of poverty and out of the trap that we've created here and to get them to work so
we haven't any thing we're moving in that direction with our call centers or anything that we're doing to get
Speaker 13
50:07
people connected to workforce or to education so we are with the call center yes we'll be connecting people with this work requirement through
Speaker 80
50:13
the call center and we do that as well in the snap program through our employment and
training program in TANF we we also do that in general we also include information about services available through the division of workforce connections in all of our notices Medicaid we don't often see folks in person for Medicaid it is it's it's handled through the mail or electronically they aren't required to see us in person at all so we do provide
Speaker 80
50:50
And, you know, we are open to things that we are allowed to do and that we can do based on funding and cost allocation and things like
Representative Mary Bentley
Unverified
50:58
that. So in those counties that we're actually doing, the Governor's 1033 plan, where we are trying to connect those people to Restore Hope and Hope Hub and all that, is there a way for us to do, maybe through TANF or some other funds, to get the funding that we would need, some cost allocations to connect those families to that electronic hub? Is there a way for us to be able to do that? just a thought moving
Speaker 74
51:20
forward so yes yes ma'am i know that that has been under discussion and
we've been working with cody waits and others on the 1033 initiative and the connections we um we are looking at the impact of funding and the cost allocation i just don't have we don't have a clear
Representative Mary Bentley
Unverified
51:36
answer today we are open to so we can we are just in discussion of possibly being able to
Speaker 74
51:42
do that it's my question I believe so it's just not an easy answer with with the cost allocation and so we do have we have been working with Cody Waits and at workforce services on the education and training with snap we've also been under
discussions of doing different things in offices we just don't have a clear-cut operational path yet great
Representative Mary Bentley
Unverified
52:04
because you know and counties we're seeing you know where we have new core, we have new
steel things going, where people are actually getting a job and moving forward. So our whole purpose is really to help families get connected and moving forward
into work. So I appreciate that. Any other questions from these folks before we
Senator Jane English
Unverified
52:24
move on to Center English? Okay, so I guess what I have found out myself about the SNAP program
is that it is about a $600,000 a year program. I'm thinking, I'm wondering, with about three or four contracts, adult education and Northeast College and Shorter College, and I don't know who the other one is. And I guess from the work that our consulting company did was found that there really was no major change
in the folks who had applied for those SNAP that opportunity. I guess my question is that how do we allow them, which goes to this cost allocation thing, how do we allow people in general to be able to access more than just the adult education program or shorter college or whatever to be able to take advantage of some of the programs that are out there for free
that they never have access to right now if that's the only place they can go is to that SNAP ENT program. And the other reality is that we have, what, 175,000 people? How is a program of $600,000 a year with a limited number of contracts going to take care of that number of people how are we giving folks an opportunity to actually
do something better than just have a benefit i
Speaker 80
54:09
think senator english you're talking about our snap employment and training program and our so there are two different pots of money that help fund that one the 600 000 i think you're referring to our hundred percent right funds it's a little bit more than that i don't have the exact number but um it's less than a million okay and that is one part of the funding for the snap employment and training program and then beyond that the
providers that we work with fns reimburses them 50 of the allowed cost so and and that number depends on how much the providers have to invest in the services that they provide to snap recipients and then get reimbursed for half of that. So the total number of investment is going to be more than $600,000. But that is part of what we are discussing with Workforce Connections now is a way to expand our partnership with them
so that SNAP employment and training clients would have access to services, all the services provided through their
Speaker 73
55:16
provider list, their approved provider list. And that, to me, that's what we need to be looking
Senator Jane English
Unverified
55:23
at is what are the overall opportunities for people. Right now what we're talking about is we're keeping people in these little boxes because this is all they can use, all they can do. And I don't think that's what we're all about.
I think we want something bigger and better for all these people. I don't care whether they're Medicaid or SNAP or just somebody walking in the door who doesn't know anything about any of these programs and isn't attached to them but really want to try and figure out how they do something better for their life. But what my feeling is is that we have terribly limited the opportunities for people to change their lives. If we have an opportunity to use the Workforce Connections
and all the services and all the things that are out there in the state right now, it's fantastic. I mean, it's not perfect, but my gosh, there's a whole lot of stuff out there that could help people
Speaker 80
56:25
move to a different place. Yes, it's my understanding that their eligible training provider list has more than 100 different, you know, providers on that list. So we are in discussion and hopeful that we can expand our partnership with Workforce
Senator Jane English
Unverified
56:40
Connections. And then we've changed the Workforce Challenge program, which is similar to the federal Pell, Workforce Pell Grant.
But that is, there's no income requirement. And now we've got all kinds of folks who have signed up and have gone through a rigorous process to make sure that their programs are good. We need to let everybody take advantage of whatever is out there. And some of those are up to $3,000. Yes, ma'am. So people could have an opportunity. We just need to make sure it's available, not keep them in a box. And many of those
Speaker 13
57:18
opportunities are available whether someone receives SNAP or doesn't,
whether they receive Medicaid or they don't. So, yes, ma'am. All right,
Representative Mary Bentley
Unverified
57:26
thank you. I guess we're ready to go on to the discussion of the denial of
Arkansas Medicaid expansion program. So if you would kindly give us an update on where we are on that,
Speaker 153
57:38
Secretary Mann, we would greatly appreciate that. Thank you.
Speaker 74
57:48
certainly let me pull out some so thank you so earlier this is August so late last month we did
have a conversation with CMS after several conversations and I'll give you some of the history that the new budget neutrality rules that were passed last January last July excuse me july 4th of 25 and then cms issued a state medicaid director letter on june 11th of this year that started the conversations about our current waiver and they have changed how budget neutrality will be measured and clarified and either deemed passing or not passing
that is the discussion of where our current waiver does not meet the new budget neutrality rules so in and just to give you all a little history on budget neutrality the the approach that we've used in the previous waivers had very little done pre-approval of the waiver we we did a budget neutrality test we we worked with cms set some limits and then we had the demonstration period
which is usually five years. Then after the demonstration period, it finishes. We go through the assessment and we identify and reconcile for savings in any rollover. So that is the old process. What is changing in that is all of that work must be done in advance of approval of the waiver. We, they've, it's very technical. You can identify what's an 1115 only service or what is
considered Medicaid authorized population and services. In the previous calculation, the and was an or. So that makes a big difference when you change an or to an and. Then you must do your financial analysis impact, and that must go to the office of the chief actuary at CMS to be signed off on. If you do not pass that test for savings, they will not approve the waiver. So that's kind
of where we are. We, in our current waiver that we did submit timely for renewal, and we went through two periods of public comment at the state level and the federal level. We've had ongoing conversations with CMS on the operations of the new waiver because we made several changes that y'all passed in the 25 session on MLR and rebates being the two biggest pieces. So we've been working with them on those pieces. In addition, when the letter came out,
the conversation shifted obviously to the budget neutrality so we we know that we will not meet it we have asked for a two-year extension I think the most important thing to to say is we are focused on finding a solution for the expansion population I am optimistic that they will grant and extension i do not feel that people will be going without coverage on january 1. um those are
some of the highlights i i think um if if that is okay i'll open it up for questions after that i'm
Representative Mary Bentley
Unverified
1:01:16
after that thank you for being here today i'm gonna ask one quick one i'll get to represent
Speaker 150
1:01:21
pilkington so what is our per member per month uh cost right now
Speaker 74
1:01:31
way um i have it somewhere i think it's a i think what we are currently operating on in year five i believe is somewhere around the nine hundred and fifty dollars a month per member per month and then and when we did our
new waiver i don't i don't know i would have i've been focused on the current waiver with an extension um since they have given us that news i can pull the the the waiver that is sitting up there for public
Representative Aaron Pilkington
Unverified
1:02:00
comment. Okay, great. Representative Pilkington. Thank you, Madam Chair. Yeah, I was looking over this handout we got, and on the third bullet point, it says we look forward to our best discussion on wide range of partners as we design and implement a new Medicaid delivery system for beneficiaries. I'm curious, can you kind of give me, in your mind, what the department currently
thinks the different avenues for a new Medicaid delivery system looks like? And if there are any ones that is not being considered by the administration right now. So
Speaker 74
1:02:32
I think they fall in two categories, fee for service or managed care. I think there are multiple versions of managed care. So you have a 1932 option, which puts managed care into the state plan. It gives you some flexibilities or you can do what's called a 1915b waiver um they both have we're we are
working on a pro and con list for all of those scenarios at this stage we are considering everything we have been looking at what happens are you considering ending the program no no okay so maybe i'm not considering everything just for the record i'm not um at the agency has not looked at ending the expansion population coverage but that's thank you for the question because that doesn't come to my mind I went automatically to what do we do to have the expansion population
covered correct so um falls in two buckets as I said earlier fee for service managed care there's lots of things to consider underneath each one of those options um we have been working with our actuaries to pull data to be able to run different scenarios. Right before we walked into the meeting, I was told the first round of preliminary data is supposed to be in somebody's inbox in my office. We have not looked at it. So that's where we're starting is what does it look
like? What does anything look like? Managed care, fee for service. So yes, we are considering everything but ending the program. Okay. Maybe I should qualify like that. I'm just curious what paths the administration would
Representative Aaron Pilkington
Unverified
1:04:12
consider taking i mean obviously i'm sure there'll be legislative involvement recession around the corner just kind of helping to get clarity on this thank you thank you representative richardson thank you madam chair over to your left thank you guys for being here so i
Representative R. Scott Richardson
Unverified
1:04:30
guess i'm asking the question i'm asking you i don't mean it i'm gonna ask you this
question you made a point just a second ago you don't feel like people are going to go without healthcare. Was that an accurate statement
Speaker 74
1:04:47
conversations with CMS, CMS has committed to working with us to maintain coverage while we work through what we do as a change. So that is why we sent the formal letter asking for the two-year extension. I'm hoping to talk with them this week as a follow-up. I am optimistic that we will get an
extension. So I am operating under the premise that coverage will exist on January 1 and throughout the time period while we work through a new
Representative R. Scott Richardson
Unverified
1:05:18
delivery system. So what would be
Speaker 74
1:05:20
the contingency if it doesn't? The contingency is, according to the statute and my lawyers, that we can move everyone to fee-for-service. That would be bumpy for the beneficiaries and fairly quick. So I think it would be disruptive potentially to providers and beneficiaries i'm hoping to avoid a disruption
Representative R. Scott Richardson
Unverified
1:05:41
or bumpiness as much as possible okay i can
Representative Mary Bentley
Unverified
1:05:46
i can continue this question after this sir
Representative Les D. Eaves
Unverified
1:05:52
yes sir thanks thank you representative representative eaves oh okay thank you quick question is there any evidence that would indicate if we removed the expansion population from private insurance What effect that would have on commercial insurance policies, whether
Speaker 74
1:06:08
we've asked. We have reached out to AID for some specifics. We have heard lots of different numbers.
I have not seen the actual calculations of what it would do to the marketplace. There is the potential for disruption in the marketplace. We have approximately 160,000 lobs on the current marketplace, which I think has a total of 250. so I do think there will be some change there I just I can't give you a number yet because I have not seen the evidence I've heard rumors but I've not seen the calculation are you expecting to
Representative Les D. Eaves
Unverified
1:06:39
get that information we have someone's compiling that to see what that's going to look like
Speaker 74
1:06:44
yes sir we have we've working with AID and the actuaries to give
Representative Les D. Eaves
Unverified
1:06:50
us some range of estimates okay and additionally um would there be a fallout effect on our rule well I guess every hospital that accept commercial insurance, if we transition that expanded population to traditional Medicaid or some other model which pays less than the commercial carrier, would there be an effect to hospitals? There could
Speaker 74
1:07:12
be an impact to hospitals no matter what change is made.
Under H.R. 1, the OBRA limit or the upper payment limit is Medicare. So we are looking at Medicaid paying at no higher than the Medicare limit. currently in traditional fee for service we have what's called an upper payment limit payment for hospitals and that is a payment designed to help them bridge the gap between medicaid and medicare it's paid every year so either we don't know the impact to what would happen to upl would it grow
would it not grow there were several other legality changes to the upper payment limit and provider taxes that we are having to factor into our analysis from hr1 last year okay one
Representative Les D. Eaves
Unverified
1:08:05
the economic effect of taking this population off of private insurance are there insurance premium taxes on that yes
Speaker 74
1:08:13
sir they do we do collect a premium tax of 2.5 percent on the our home population every year that is used by the medicaid program to help
match and pay for the medicaid program that is also being factored in and and and where i where i go with that if it goes to fee for service there is no premium tax if it goes to a form of managed care there will there could be a premium tax it will be lower let i mean i'm just not going to sugarcoat it it will be lower okay well thanks for the info yes sir thank you
Senator Joshua Bryant
Unverified
1:08:49
representative uh senator bryant thank you madam chair um no doubt this is going to be a very bumpy
ride for the majority of the legislators that did not experience this you know back in 2012 you made a comment that you're not considering what ending the expansion population looks like like you're focused on managed care or fee for service but there is an uh i guess we need to make sure we do our correct math because there is a cost to the state to not expanding care correct the uninsured souls you know what what we see the other 10 states that have not expanded coverage since the platform came out there is a cost correct yes sir and it's actually nine now
Speaker 74
1:09:33
i answered representative pilkington's question we are not doing the calculations or advocating or doing anything to end the program i do think as we have been looking and asking for different data analysis to be run somewhere on the list is exactly what you just asked me what is the cost to the state what is the cost if we were to end this i just we haven't had a chance to model it yet okay but those numbers
Senator Joshua Bryant
Unverified
1:10:05
will be generated for those that ask the question am i going to spend more ending the program versus just accepting expanded population i feel sure that it will be in the long
Speaker 174
1:10:13
list of models yes sir okay thank you okay thank you so much for
Representative Mary Bentley
Unverified
1:10:20
being here i think it's a topic we're just getting started i really appreciate the information you guys have brought today so um one last thing before we let you go we need our update on reimbursement rates under the living choices assisted waiver yes sir
Speaker 74
1:10:34
yes ma'am excuse me thank you um in your packet you do have a copy of our
letter for for um the ending of july where we have been working on the assisted living cost report analysis and updates they did ask for an extension to july 31st they did deliver the report the report is currently out for public comment um for 30 days i believe it went out early um august it did not go out the exact day that it came we took a few days to review it we put it out for public comment after those public comments are received then we will be bringing forth a recommendation
Representative Mary Bentley
Unverified
1:11:13
all right thank you very much and you're free to go all right um so colleagues we need to have a discussion about this the um you know this group this subcommittee was tasked with two specific pieces of legislation some things that we need to get done if you look under we have some little uh they've divided this up between two as a gold a gold section at the very beginning if you go to the second page behind the very beginning gold thing you'll see our timeline for act 145 2025 sorry yeah act 1004 so that timeline if you look at it um where we need to be this the
dhs report is not due until january but if you look on there we kind of switched the agenda for august with september so if you look at their first agenda we did today's talk about snap and medicaid and tanf so next month in september we will be talking about dcfs foster care and those things and some of that come to show you know what next month looks like but we are you know task was coming up with some implementations by the end of the year on dhs and what we want to see with what's going on with medicaid i see that we have some very important things to discuss so just guys keep you guys on top of that and under the next gold of leaf you'll see our our other
timeline that we have for workforce so you go to another big section there's a big gold divider and so under that act 145 we need to have a final report due to alc october 1st from this committee on what we want to see implemented regarding workforce and social services so time is getting close to october so we'll be having some more discussions here on thursday i will visit with senator english to see if maybe we can't ask for an extension october at least to
the week of ALC instead of October 1st see if we can't ask for an extension to get something the week of ALC instead of the very first of October so any suggestions that you guys have to us for the subcommittee we're open to any thoughts or ideas that you want to submit to us to the subcommittee you guys can bring a member of the committee can bring those thoughts to us we continue moving forward I think as we look forward what's going on with SNAP requirements and all those things in workforce it's very important that our constituents in every county are available to every workforce has available in educations. I think it's very important with the money that we're spending,
that we spend it in that direction. So we'll be pushing that. And we have it here from committee members on any thoughts you have. Does anybody have any thoughts that they'd like to share right now before we end? I'm happy to take any comments or thoughts at this point you have. Okay. If not, I thank you all so much for your time. This is very important. I'm excited us to be engaged and involved in doing some great things for our Kansans. Have a great day. Where is that one?
Agenda
A. Call to Order
B. Presentation on the Implementation of Work Requirements for Medicaid Beneficiaries [Exhibit B]
C. Discussion of the Denial of Arkansas’s Medicaid Expansion Program Request [Exhibit C]
D. Update of Reimbursement Rates Under the Living Choices Assisted Living Waiver Pursuant to Act 213 of 2022, Section 15 [Exhibits D1-D2]
E. Discussion of Recommendations by Subcommittee
F. Other Business
G. Adjournment
Documents
No documents posted.
Speakers
Representative Mary Bentley
Unverified
Speaker 9
Speaker 12
Speaker 13
Speaker 16
Speaker 20
Speaker 28
Senator Jane English
Unverified
Speaker 43
Speaker 44
Representative Les D. Eaves
Unverified
Speaker 52
Speaker 56
Representative Ryan A. Rose
Unverified
Speaker 26
Speaker 64
Representative Fred Allen
Unverified
Speaker 74
Speaker 17
Representative Denise Garner
Unverified
Speaker 91
Representative Aaron Pilkington
Unverified
Senator Justin Boyd
Unverified
Speaker 80
Representative Rick Beck
Unverified
Speaker 51
Representative Denise Jones Ennett
Unverified
Representative Stephen Meeks
Unverified
Speaker 55
Representative Ashley Hudson
Unverified
Speaker 118
Speaker 96
Representative Stetson Painter
Unverified
Speaker 73
Speaker 153
Speaker 150
Speaker 154
Representative R. Scott Richardson
Unverified
Speaker 14
Speaker 168
Speaker 58
Senator Joshua Bryant
Unverified
Speaker 174