ALC - Hospital, Medicaid, - Developmental Disabilities Study Subcommittee
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- October 2, 2026
Representative Mary Bentley
Unverified
2:29
for everybody to get to their seats we're about to get this committee started right we'll call this subcommittee meeting to order. thank you all for coming out on a hot summer day. hope everybody's having a good summer
and 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 but we're going to start this morning with Secretary mann 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 gonna 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 uhpresentative beck would you lead us in just a moment of prayer before we get started and I can't get up and represent him English camp but the rest of y'all will thank you.
amen thank you Representative Beck. OK, if you guys will recognize yourselves who
Speaker 13
4:16
morning uhjanet mann DHS. good morning Mary Franklin DHS division of
Speaker 16
4:24
county operations. right good morning we are here
Speaker 13
4:27
to talk to you today about community engagement and work requiring requirement that is coming to the our homemey could you move that speaker just a
Representative Mary Bentley
Unverified
4:38
little bit mic a little bit closer to you thank
Speaker 13
4:42
you very much. Is that better? good morning we're we're here today to talk about community engagement and work requirement that is coming to the medicaid program it is it will impact the our homeme eligibility group which are individuals aged 19 to64, 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 lunch we 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
Speaker 20
5:27
business 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 they will be implemented
January1 of27. So the our home
Speaker 13
5:42
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 six month cycle and that will impact all of the our 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 lookback period will be used in the same rules are going to apply for work and community engagement when someone requests
Speaker 20
6:28
retroactive coverage retroactive coverage in our home is already uh30 days prior to application or the month before and that that we already had in place with our waiver here in Arkansas but it is changing federally for any of the adult expansion populations
Speaker 13
6:48
to30 days. Um, so if they request 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
Speaker 20
7:03
also called exclusions and exceptions by Cms just wanted to call that out and they'll be verified at
Speaker 13
7:11
both application and renewal Next we're gonna talk about specified excluded individuals some individuals in our home
will not be subject to community engagement and work requirements andcms calls these individuals specified excluded individuals they won't be subject to that lookb 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, orn
Indian urban Indian and Alaskan natives.arents and caretakers of children aged 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 lookb back period. So the exceptions
include those who are underage 19, those who are entitled to are enrolled in medicare Part A or B or the specified excluded individuals are also accepted from that lookback period and those who have a short term hardship in 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 decla ration 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 US Health and Human Services secretary approved 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 socialcialcuritydministration qualifies as a specified excluded individual individual with a VA rating of 100% will also be a special specified excluded individual ed providers will be able to complete a form regarding the individual's disability for those who are not established as disabled by socialcialcurity or
VA individuals 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 est ab li sh 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 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 lookback 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 during the renewal period. so compliance with requirements
an individual meets the requirement if they work at least
Speaker 20
12:02
80 hours a month? or they earn or have income the equivalent of federal minimum wage and right now
Speaker 13
12:13
that equivalent that monthly equivalent equals580 dollars 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 ins educational program at least half 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 8yhour requirement then they will also be considered compliant.
so I'm gonna run through some examples just to help help maybe clarify what all that means particularly about the income in the580 dollars a month. this is something that Cms has clarified that if the magi household has income that totals580 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 accountable income in the magi household that's580 dollars a month then that household is considered compliant so here's an example example one Mary andri are in the same magi household and Mary earns580 a month. both of them are compliant. an example too Mary andri are in the same household. Mary earns300 per month andri receives300 per month unemployment benefits for a total household income of600 dollars. they're both compliant
because that total household income is more than580 dollars a month. In example3 Mary andri are in the same household. Mary earns $100 a month.ri earns300 dollars a month for the total of400 dollars a month.neither one neither are compliant and Mary with her $100 has 14 hours towards that 80 hour a month requirement andris has41 hours so just wanted to share those
examples to help clarify income some additional information I want to share with you about the community engagement requirement part-time students so if they are not at least halftime considered halftime by their higher education institution then we're going to calculate their
Speaker 20
14:53
compliance with the part time hours by multiplying their credit hours by3 and then multiplying that by4.333. that's
Speaker 13
15:03
because there's a little bit more than4 weeks in general 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 gonna to round up to th3th. 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
Speaker 20
15:36
we're gonna count class time hours or educational activity hours on a weekly basis to calculate that monthly number of hours toward compliance
Speaker 13
15:45
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. OK
Speaker 28
16:29
we're gonna stop right there we've got a
Representative Mary Bentley
Unverified
16:32
few questions then we'll then we'll finish up Maryfra OK thank you we're gonna start with Senator English.
Senator Jane English
Unverified
16:42
thank you can you go back to the examples here just a minute Sure So I I'm a little confused so we're saying that people have to have be working in order to get medicaid unless they're in one of these exempt groups I'm a little confused about the the 30 $0 andris receives300 dollars in 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 than580 dollars a month. I I I don't I don't understand what we're doing with
Speaker 20
17:25
people here well the 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 is7 dollars 25 cents an hour if you multiply that by 80,
that's580 dollars 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 earn580 dollars that's all they have to earn yeah they have to earn580 dollars in in addition to that CmS has the law says based on the magi household's income if they're income is580 dollars and income can be more than earnings it can be other things that we have to
count if they have income of580 dollars a month in that household is meeting the
Senator Jane English
Unverified
18:23
requirement. so they then go to the part time students and all that so if it's for credit hours or some of the noncredit courses are they the same it's a treated the same so the credit
Speaker 20
18:38
hours where we multiply by three and then multiply that again by4.33 to get monthly but if they're in
Senator Jane English
Unverified
18:47
a short term training program like atuaLR or plastic tech or whatever how do you do that that's because those aren't for credit those are just well
Speaker 20
18:55
those we would count class time hours and sometimes you're you're in class all day right?5 days a week for those types of training it's just going to depend on class time and educational hour how how many hours does that total and then we would multiply that by the same factor. so then I guess my
Senator Jane English
Unverified
19:13
probably my biggest question is how do we
get these people to these things so that they have the opportunity to to better themselves how
Speaker 13
19:24
are we doing that? so one of the things we are going to do and that's on our my
Speaker 20
19:30
actually last slide of information we are working on implementing a contract we have already done the uh, procurement and evaluation we've done an anticipation to award and there were no protests that contract is currently
Speaker 13
19:41
being reviewed by CmS and FNS and we plan to bring it to you we hope
Speaker 20
19:48
next month we 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
20:04
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 individual30 days to show
us how they have met these rules either been
Speaker 20
20:24
exempt or compliant. 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
Speaker 43
20:51
this this referral system can make that referral and then give us feedback on what the outcome of that referral was so
Representative Mary Bentley
Unverified
21:02
is service delivery OK Representative Eads Eaves thank you just a
Representative Les D. Eaves
Unverified
21:08
quick question the number do you have the number or percentage of folks who are right now covered under our homeme who are also receiving snapper tannoff benefits
Speaker 13
21:22
looked before this meeting this morning just to check that our homeme enrollment it was between 215 and216,000. 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
21:37
percentage and those people if they're receiving snap or tanf or excluded or exempt from the
Representative Les D. Eaves
Unverified
21:47
that number of folks that are receiving those
benefits is over half of our
Speaker 26
21:55
home population it's it's a pretty high percentage. yes sir.
Representative Ryan A. Rose
Unverified
22:09
thanks RepresentativeRose, your thank you Director Franklin thank you for your presentation thank you for taking the time you mentioned when it came to the the 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 um'm I think if it
Speaker 13
22:45
a lot of higher education is based on credit hours but I
Speaker 26
22:50
think there are certification type classes that are not based
Speaker 13
22:55
on credit hours I I really don't want to misspeak. I I don't know exactly what those are but I suspect it might be something like welding where you're you are working towards
Speaker 26
23:08
a certification but not necessarily earning credit hours and so the class time while you're working on that welding certification those hours
Speaker 64
23:17
are going to count towards meeting that requirement
Representative Ryan A. Rose
Unverified
23:20
so and 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 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.'m curious if that would count. There may be organizations that would benefit from that as would the the parents who are trying to
navigate this process I'm not necessarily suggesting we change rules but I'm interested in what would qualify Yes
Speaker 13
24:02
sir and and you know, I I'm on the same page with you and we will base it on any Cms guidance along 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 coursed'd be interested if we could get just what those
Representative Ryan A. Rose
Unverified
24:27
requirements are because I think there's a lot of groups out there who would be mutually beneficial for what their mission is for ourkansans and and making sure that everybody could be in compliance with that thanks for the latitude madam chairir. you're welcome thank you Representative Allen.
Representative Fred Allen
Unverified
24:43
thank you thank you madam chairman. My question to you is do you all have the manpower to keep up with the new requirements So we
Speaker 13
24:58
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 1el months to6 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. I understand that
Representative Fred Allen
Unverified
25:29
but my question is do you all have the manpower to keep up with the new requirements if not it's gonna be obvious that it's gonna be challenging and difficult for some of the people and many of them will fall within the
Speaker 74
25:48
cracks sir thank you for the question. I'll just expand onrector Franklin's answer. we are we are monitoring the manpower. Yes, they're 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 in part of the reason of doing the soft flies 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 don't know that we will have a complete answer until we finish a cycle
when we go when we do the live with the with the adverse actions starting in January
Representative Fred Allen
Unverified
26:37
1 last follow up how are you all going to disseminate the information out there so the recipient will know what the new requirements are so
Speaker 17
26:46
we have we have already been working on that
Speaker 20
26:49
we are doing we've sent notices to the entire our homeme 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
Speaker 13
27:07
follow up emails 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 coms team has also created a special web web page called aar.gov/engage where we keep information updated on that requirement. We did a series of
Speaker 20
27:32
five in-person town halls over the last several months and we will continue to to do things like keep
Speaker 64
27:40
our information updated continue to reach out to clients and then this outbound verification center that'll be coming online very soon we'll also help to make sure beneficiaries know and understand their requirement Representative garner
Representative Denise Garner
Unverified
27:54
thank you madam chairir. 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 get are in renal failure and getting dialysis everyday are are you saying that if a physician gives you that information that that will put them into that that group
Speaker 13
28:26
that is eligible so we do have a clinicians at DHS working on figuring out those diagnoses and accompanying
claims codes that would indicate someone has a special medical need that would that would make it difficult for them to do the community engagement activities 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 socialcial
Securitydministration 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 Individual circumstances can vary and the 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
Speaker 26
29:36
do community engagement due to their medical condition that provider can complete that form and send it
Representative Denise Garner
Unverified
29:46
back to us. Willu will you give us a list of those things as soon as you those diagnoses as soon as you have them are those medical codes can we get that information please? and and my second question is that you've talked about 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
Speaker 13
30:19
but just the contracts how much are the contracts costing? 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 that'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 we will just be bringing a new contract for customer service
Speaker 26
30:45
center that will replace the existing one to you guys so we're essentially already spending this money on both of those contracts great I just left a note that3 and and we're not adding services
Representative Denise Garner
Unverified
30:58
or adding costs 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 the contract without
Speaker 13
31:10
adding we're getting additional services in the customer service center it will include some virtual capabilities for to help clients and with with selfservice and it will include this outbound verification center and it will also include the closed loop referferral 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 a savings over the existing I just don't
Speaker 20
31:36
have the numbers great thank you very much
Representative Aaron Pilkington
Unverified
31:42
thank you Representative Pillington you're next. Thank you chair. on page four on the excluded individuals there's pregnant women are those and their postpartum coverage. how long is that postpartum coverage? I that6 weeks or 1el months? It's60 days 2
months months OKok is that the same in every other state No I
Speaker 13
32:06
do belo 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
Representative Aaron Pilkington
Unverified
32:20
period of time so if it is based on individual states every other state that implemented these rules would be a 12 months but Arkansas would be at60 days. Is that my correct understanding of
Speaker 13
32:34
your statement? if that is what I need to confirm that with thecms guidance if the guidance is based on state's
Speaker 64
32:40
postpartum period versus an established postpartum period in the community engagement
requirement. I just don't know that answer but
Senator Justin Boyd
Unverified
32:55
I will get it for you. I'd appreciate that Thank youpresentative Senator Boyd. thank you madam chairir. just 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 one is that correct?
Speaker 80
33:21
That is correct and actually that person would be moved out of the our homeme category because if you have medicare eligibility
Speaker 64
33:27
you're not eligible for our home. so if we discover someone has medicare it moves them out of the category you answered my real
Senator Justin Boyd
Unverified
33:33
question is why would they be in our home? Thank you. thank you. I'm gonna jump in here
Representative Mary Bentley
Unverified
33:39
before I take the next question. So going back to the postpartum period if we know that parents or caretakers of a child aged 13 or younger are
exempt I don't understand I mean they have a new baby so they're going to be exempted when the child is under 13 so I'm not I'm curious to the quandary there it's gonna be I mean the child they have a child that's under 13 so they're going to be exempt anyway
Speaker 17
34:00
they would be exempt if they have a child in the home
Representative Mary Bentley
Unverified
34:02
under they they've given birth to a new baby they're going to be exempt for 13 years actually most likely yeah ok just jumping back to that p re s ent ative Beck thank
Representative Rick Beck
Unverified
34:13
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 of it it's like the institution gonna go to fill out a form that says I'm doing this many hours a week or would the end is that
Speaker 13
34:37
institution so we hope not that would be a possibility but we are working on an interface with the nationaludent C clearingho and further we are also working with the state datata hub team to see what
we can get of this ex parte but that
Speaker 26
34:55
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 dayy 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 gonna try to get it through data sources
Representative Rick Beck
Unverified
35:13
so is is that classroom that the times I being in the classroom or is that just what I was scheduled to be in the classroom you know I might not
Speaker 13
35:24
show up for classes so weu we would we'll be verifying that they meet student status like they are enrolled in 12 college hours or
Speaker 26
35:31
or whatever that 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. right so is that the the rules
Representative Rick Beck
Unverified
35:48
that were handed down so the requirement is that you have
Speaker 13
35:57
to meet it at application and at renewal during the
Speaker 26
35:59
lookb back period in Arkansas we we are planning a one month lookb back period at least as we start this work requirement
Speaker 64
36:06
because it's a big 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 Ennett
Representative Denise Jones Ennett
Unverified
36:40
thank you chairwoman. I have a question Miss Franklin is it I'm sorry I was late to this conversation you might have already mentioned it on page six disability and special needs or special medical needs is there a appeal process to this or correction action piece to this so anytime we take an adverse action
Speaker 80
37:01
a client has a right to file an appeal and is it clearly stated how
they can do that. Yes, all of our notices have appeal rights on them and how
Representative Denise Jones Ennett
Unverified
37:17
to file an appeal instructions. I have one more question also does this interact with the CES waiver or the passes in any way no ma'am ok thank you you're
Representative Stephen Meeks
Unverified
37:35
welcome. Representative meeks right here in front thank you. so my one of my colleagues just triggered 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 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 that the best possible world is the AI will do a lot of computer work so that 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
Speaker 13
38:58
help with some of these workload issues. Absolutely thank you for the question we have started using AI the first thing we use 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 if it can't approve the the coverage then we create a task for the worker and the worker takes
Speaker 26
39:23
it from there and gets the newborn applica newborn covered we are going to soon implement a voice agent that goes along with
Speaker 64
39:31
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 they if they're missing you know missing blanks
Speaker 26
39:43
missing information we need and to
additionally help the worker but again if if a worker needs to look at it then
Speaker 13
39:52
it'll go to a worker to look at so that is the first thing we did we have also recently implemented a bot to help us with national directctor of new hire tasks nationalrectory of new hireervice is something we are required to participate in for thesnap 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 of weeks launched a returned mail bot which looks at all the return 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 it's called case
Speaker 55
40:49
IQ but it is providing real-time feedback to a worker as they are getting ready to authorize a case to
Speaker 13
40:55
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 bought to help us do very similar things
Speaker 64
41:27
for 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 to move forward with AI for use cases that that makes sense for us and I will point out that this
customer service center, one of the requirements we had in the RfP is
Speaker 13
41:55
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 but the
Speaker 20
42:17
goal is not to block access but only to make the process better
Representative Stephen Meeks
Unverified
42:22
and more efficient I'm'm 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 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 the whole point to the AI should be to free up our people so they can talk to other people so and it sounds like you're heading in that direction so will have the human in the loop excellent that's what we want to see all right thank you thank you representative meekspresentative hudson
Representative Ashley Hudson
Unverified
42:54
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 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 8 to5 may not be a good time to reach them. So what efforts are being being made on the low end part of the scale.
Speaker 118
43:50
so one of the lessons learned from the last work requirement was moving away from that
Speaker 26
43:56
monthly reporting requirement so this 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 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 get30 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 Access Arkansas and
Speaker 13
44:57
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 with
Speaker 64
45:13
us in multiple ways and provide information in multiple ways. OK. Representative Eaves just a real quick question on
Representative Les D. Eaves
Unverified
45:28
the school credit hours a minute ago you said that you would multiply the credit hours by3 and then you said if you're taking one threehour course you would just multiply that by4.33 but the slides says you multiply the credit hours by3. So would you multiply that3 and then by4.3 Let me double checkck my math on that
Speaker 96
45:55
for youpresentative Eaves you can just get back to us
Representative Stetson Painter
Unverified
45:59
whenever you can OKpresentative painter thank you madam chairirpresentative E took my question but my second question is sparked off of a Representative Ggarner's questions you know me and in contracts where is that call center out of is that here in Arkansas or is that
Representative Denise Jones Ennett
Unverified
46:29
ok thank you OKpresentative Ennnett thank you madam chairir. I have one more question once a person is under the specified excluded individual category is there a regular check-in do they have to establish their client not claim but do they have to re up it every so often is there a
Speaker 80
47:00
schedule there so if the person is an applicant and 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 that renewal so at renewal if they are exempt and 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 we're going to be looking at application and at renewal thank you
Representative Mary Bentley
Unverified
47:34
OK I've got a couple of questions so we're going back to snap and tanna 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 work requirement correct yes
so how are we can you go over us what the current caseload is how many how many case workers do you guys currently have? what's their caseload we're looking 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 low a
Speaker 55
48:10
breakdown you know I want that sucking nightmare need
Speaker 80
48:13
to bring that back to you 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 taf program where our case managers that's their focus. They they do case management for ourT andorkpays 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 we do integrated eligibility so the workers are flexible and they can hit if the client has Medicaid andsnap
Speaker 64
48:49
or Medicaid Snap anti they do it all right so this the subcommittees we're looking
Representative Mary Bentley
Unverified
48:54
at workforce right and getting folks to work because we know workers are 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 twoyear college inortalton students some amazing things that 9 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 that to this population to where we can connect them to workforce and simple and seamless way so we can actually get families moving forward because again that that's the whole purpose not to be spiteful but to get families out of poverty and then 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 anything we moved in that direction with our call
centers or anything that we're doing to get people connected to
Speaker 13
50:08
workforce or to education. So we are with the call center yes we'll be connecting people with this
Speaker 80
50:18
work requirement through 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 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 that information in the form
Speaker 20
50:51
of notices and you know we are open to things that we are allowed to do and
Speaker 80
50:56
that we can do based on funding and cost allocation and things like that so in those counties that we're actually
Representative Mary Bentley
Unverified
51:03
doing with the governor's 1033 plan where we're trying to connect those people
to restore hope and hopeubb and all that is a way for us to do maybe through tanna for some other funds to get the funding that we would need some cost allocations to connect those those families to that to that electronic hub is there a way for us
Speaker 74
51:25
to be able to do that just a thought moving 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 we are looking at the impact of funding and the cost
allocation. I just don't have a
Representative Mary Bentley
Unverified
51:41
we don't have a clear answer today we're open to so we can we are just in discussion of possibly
Speaker 74
51:47
being able to do that it's my question I believe so it's just not an easy answer with with cost allocation and so we do have we have been working with Cody Waits at Workforce Services on the education and training withsnap we've also been under discussions of of doing different things in offices we just don't have a clear cut
Representative Mary Bentley
Unverified
52:10
operational path yet. great because you know and counties we're seeing you know where
we have new core we have new steel things going we we're people actually getting a job and moving forward so our whole purpose is really to help help
families get connected and moving forward into work so I appreciate that any other questions
Senator Jane English
Unverified
52:29
from these folks before we move on upenator English. OK so I guess what I have found out myself about the snap
program is that it is about a600,000 dollars a year program
I'm thinking I'm wondering with about3 or4 contracts ul t education and Northeast College and shorter collegelege and I don't know who the other one is and I guess from the the work that our our consulting company did was found that that there really was no major change in the folks who had applied for those snap that opportunity I guess my question is 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 E
EnT program and the others reality is is that we're gonna we have what 175,000 people how how is a program of600,000 dollars 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 think senator
Speaker 80
54:14
English you're talking about our Snapmployment and training
program in our so there are two different pots of money that help fund that 1 the600,000 I think you're referring to our 100% funds it's a little bit more than that I don't have the exact number but it's less than a million OK and that is one part of the funding for the Snapmployment and training programme and then beyond that the providers that we work with FNS reimburses them50% of the allowed costs 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 gonna be more than600,000 but what that is part of what we are discussing withorkforce 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
55:22
provider list they approved provider list and that that to me that that's what we need to
Senator Jane English
Unverified
55:28
be looking 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 that they because this is the all they can use all they can do and and that's 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 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 it's fantastic I mean I it's not
perfect but my gosh there's a whole lot of stuff out there that could help
Speaker 80
56:30
people move to a different place so yes it's my understanding that they're eligible training provider list has more than 100 different tra you know providers on that list so that's we are in discussion and hopeful that we can expand our partnership
Senator Jane English
Unverified
56:45
with Workforce Connections workforce challenge program which is similar to this the federal ell workforce pell grant but that is there's no income
requirement and and now we've got all kinds of folks who have 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 and some of those and some of those are up to3,000 dollars so people could have an opportunity we just need to make it make sure it's inva available not keep them in a box and many of those opportunities
Speaker 13
57:23
are available whether someone receives snap or doesn't whether they're receive medicaid or they
Representative Mary Bentley
Unverified
57:27
don't so yes ma'am all right thank you I guess we're ready to go on to the discussion of
the denial of Arkansas medicaid expansion programme. so if you would kindly give Snup deadad and where we are on that Secretary mann
Speaker 153
57:43
we would would greatly appreciate that thank you certainly let me
Speaker 74
57:53
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 July4th 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 a 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 y'all a little history on budget neutrality the the approach that we've used in the previous waivers had very little done preapproval of the waiver we we did a budget neutrality test we we worked
with umcms set some limits and then we had the demonstration period which is usually5 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 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 that 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 stay is we are focused on finding a solution for the expansion population I am optimistic that they will grant an extension. I do not feel that people will be
going without coverage on January 1 those are some of the highlights I think if if that is ok I I'll open it up for questions after that I' after that thank you for being
Representative Mary Bentley
Unverified
1:01:21
here today I'm gonna ask one quick one though'll get to uhpresentative Pilkington. So what is our per member
Speaker 150
1:01:26
per month cost right now but what we were asked for in the waiver I
Speaker 74
1:01:36
I think what we are currently operating on in
year5 I believe is somewhere around the $950 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 since they have given us that news. I can pull the the the waiver that is sitting up there for public comment. greatpresentative Pilkington thank you madam chairir. yeah
Representative Aaron Pilkington
Unverified
1:02:05
I was looking over this handout we got and on the third
bowl point, since we look forward to a robust discussion on a wide range of partners as we as we design and implement 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 think they
Speaker 74
1:02:37
fall in two categories B 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 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 ending the state plan. it gives you some flexibilities or you can do what's called a 1915b waiver 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 ending No no ok so maybe I'm not considering everything just for the record I'm not at the agency has not looked at ending the expansion population coverage but let's thank you for the question because that doesn't come to my mind. ma eye went automatically to what do we do to have the expansion population covered so 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 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 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 and what does anything look like managed care fee for service. so yes we are considering everything but ending the program. Maybe I should qualify
Representative Aaron Pilkington
Unverified
1:04:16
like that I'm just curious what paths the administration would consider taking. I mean obviously I'm sure there'll be legislative involvement the session around the corner just kind of help ing get clarity on this thank you thank you Representative Richardson thank you madam chair over here to your left thank
Representative R. Scott Richardson
Unverified
1:04:35
you guys for being here. So I 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 gonna go without healthcare
Speaker 14
1:04:48
was that an accurate statement I just heard you
Speaker 74
1:04:52
say? sir when our 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 the formal letter asking for the twoyear 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 and throughout the time period while we
Representative R. Scott Richardson
Unverified
1:05:23
work through a new delivery system
Speaker 74
1:05:25
so what would be 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 or bumpis as much as possible. OK I
Representative Mary Bentley
Unverified
1:05:50
can I can continue this question after this
Representative Les D. Eaves
Unverified
1:05:57
sir sir thanks thank youpresentative Representative Eaves thank youuick 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 it it's
Speaker 74
1:06:13
we've asked we have reached out to Aidd 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 lives 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 have not seen the evidence. I've heard rumors but I've not seen the calculation are you expecting to get that information we have
Representative Les D. Eaves
Unverified
1:06:44
someone's compiling that to see what that's going to look like yes sir we have we've working
Representative Les D. Eaves
Unverified
1:06:55
us some range of estimates and additionally would there be a fallout effect on our rural well I guess every hospital that excepts commercial insurance if we transition that expanded population to you know traditional medicaid or some other model which pays less than the commercial carrier would there be an effect to hospitals?
Speaker 74
1:07:17
there could be an impact to hospitals no matter what change is made underderhr one the
umobra limit or the upper payment limit is medicare. so we are looking at medicaid paying it no higher than the medicare limit.urrently 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 HR one last
Speaker 58
1:08:06
year. OK one other quick question what
Representative Les D. Eaves
Unverified
1:08:10
would be the economic effect of taking this population off of private insurance are there insurance premium taxes on that?
Speaker 74
1:08:18
yes sir they do we do collect a premium tax of 2.5% 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 I mean I'm just not gonna sugarcoat it it will be lower. OK well thanks for the info. Yes sir thank you Representative Senator Bryant thank you madam chair
Senator Joshua Bryant
Unverified
1:08:57
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 you're focused on managed care or for service but there is an 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
Speaker 14
1:09:33
there is a cost correct? Yes sir and it's actually non now because North
Speaker 74
1:09:38
Carolina did expand recently so when I answeredpresentative 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
Senator Joshua Bryant
Unverified
1:10:09
it yet. OK but those numbers will be generated for those that ask the question amm I going to spend more ending the program versus just accepting expanded population. I feel sure that it will be
Speaker 174
1:10:18
in the long list of models yes sir OK. thank you so much for
Representative Mary Bentley
Unverified
1:10:25
being here thinks a topic we're just getting started and I really
appreciate the information you guys have brought today so one last thing before we let you go we need our update on reimbursement rights
Speaker 74
1:10:39
under the women Choices Assisted waiver yes sir yes ma'am excuse me. thank you in your packet you do have a copy of our letter for for 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 July31st they did
deliver the report. The report is currently out for public comment for30 days I believe it went out early 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 all
Representative Mary Bentley
Unverified
1:11:20
right thank you very much and you're free to go. right so colleagues we need to have a discussion about this the you know this group this
subcommittee was tasked two specific pieces of legislation some things that we need to get done if you look under we have some little 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 then you'll see our timeline for Act 145 of2025. sorry yeah act 1004 so that timeline if you look at it 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 was September so if you look at that first agenda we did today's talk about snap and Medicaid and tandem so next month in September we will be talking about DCfs foster care and those things and some of that outcome just so you know what next month looks like but we are you know task is coming up with some implementations by the end of the year on DH S we're going to see with what's going on with medicaid I see that we have some very important things to discuss so got to 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've got another big section there's a big gold divider and so under that actct 145 we need to have a final report due to ALCoctober 1st from this committee on what we want to see implemented regarding workforce and social services so time is getting close tooctober so we're we'll be having some 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 ofoctober 1st see if we can't ask for an extension to get something the wig 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 continued moving forward. I think as we look forward what's going on with snapper requirements and all those things in workforce is very important in our constituents in every county are available to every workforce that's available
in education 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 before we end them'm happy to take any comments or thoughts at this point you have OK. if not I thank you all so much for your time this is very important I'm excited for us to be engaged and involved in doing some great things for ouransans have a great day.
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 12
Speaker 13
Speaker 16
Speaker 20
Speaker 28
Senator Jane English
Unverified
Speaker 43
Speaker 44
Representative Les D. Eaves
Unverified
Speaker 56
Speaker 26
Representative Ryan A. Rose
Unverified
Speaker 64
Representative Fred Allen
Unverified
Speaker 74
Speaker 17
Representative Denise Garner
Unverified
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