LITTLE ROCK, Ark. (AP) - Arkansas Gov. Mike Beebe said Wednesday that expanding Medicaid eligibility under the federal health care law would be the best way to avoid removing thousands of people from nursing home care, but he's open to other ideas.
A day after state officials detailed a series of proposed cuts under a plan to fill a $138 million shortfall in the state Medicaid program's budget, Beebe said he wanted to find a way to avoid the nursing home reductions. Department of Human Services officials have proposed eliminating the lowest level of nursing home care under the state program, a $35 million cut that would affect between 10,000 and 15,000 seniors.
The nursing home cuts are part of service reductions or freezes that DHS officials say would affect more than 75,000 people on Medicaid in the state. Even more would be affected by other cost-saving measures, including a rate freeze for providers.
"The one that bothers me the most and the one that we would work the hardest to try to keep from occurring is the level-three nursing home folks," Beebe told reporters.
Beebe, a Democrat, said his preference would be to use the savings from a Medicaid expansion under the health care law to prevent the reductions. DHS officials project that expanding Medicaid's eligibility - covered by the federal government for the first three years - would add 250,000 people to the state's rolls and save the state $44 million next year.
Beebe said he'll consider other ideas, however, noting that the expansion would require the support of at least three-fourths of the House and Senate - a margin even more difficult after Republicans won control of the Legislature in last week's election.
"There may not be any other realistic option, but we won't preclude or foreclose any thoughts by anybody," Beebe told reporters.
The nursing home cuts faced opposition Wednesday from skeptical Republican lawmakers, who wondered whether it was an effort to prod them to support the Medicaid expansion.
"I'm not even sure I consider a proposal like that a serious proposal," said Sen. Michael Lamoureux, R-Russellville, who will be the Senate's president next year.
Under the health care law, the federal government agreed to pay the full tab for the Medicaid expansion when it begins in 2014. After three years, states must pay a gradually increasing share that tops out at 10 percent of the cost. The U.S. Supreme Court's ruling in June upholding the federal overhaul gave states the right to opt out of the expansion.
Lamoureux said the expansion and the shortfall are two different issues.
"They're wanting to tell us they're going to solve the immediate Medicaid crisis by expanding Medicaid and that's not what we want to hear," he said. "We want to hear how to solve the Medicaid crisis right now by itself."
Rep. Greg Leding, the House Democratic leader, said he believed the cuts make a strong argument for expanding Medicaid's eligibility.
"I think we help another group of vulnerable people and help protect those people who rely on and need these nursing home services," said Leding, D-Fayetteville.
Lamoureux and other Republican leaders said they want to look in other parts of the state's budget to see if there are other cuts that could be made to help save some of the Medicaid services. Beebe, who is expected to unveil his budget proposal on Thursday, said there's little room outside Medicaid and public schools to look for additional money.
Another option, DHS officials say, may be through a request Beebe has made to the federal government for a "global waiver" that would give the state more flexibility on how it uses federal Medicaid funds but would put a cap on its spending over the next eight years. DHS Director John Selig said that flexibility could allow the state to require co-pays for some Medicaid recipients, an idea backed by some GOP lawmakers.
Beebe wrote in an Oct. 29 letter to the U.S. Department of Health and Human Services that the waiver would allow the state to avoid the cuts and work on efforts to change the way Medicaid pays for services.
"By avoiding the chaos of crippling program cuts and continuing on our payment improvement path, we can commit to fully implementing Medicaid expansion, a goal I know you share," Beebe wrote in the letter, released Wednesday by his office.
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