Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and Little Rock Public Radio.

And hello again, everyone.

Thanks very much for being with us.

The Sanders administration will try it again.

A work requirement as a condition for Medicaid coverage.

Originally, a regulation struck down in the courts under a previous governor.

In a moment, the leaders at the Department of Human Services who would be directly responsible for implementing a work requirement should it survive this time.

First, though, we're a month into the regular session of the General Assembly, its 95th General Assembly, and the legislative locomotive is at full speed now.

One of the engineers joins us.

He is Bart Hester of Cave Springs.

The president pro tem.

Senator, thanks very much for being with us.

Thanks for having me, Steve.

I asked.

The Senate ended its work week, a tour of all things a tort reform bill goes through.

It was a tight vote.

It was a really tight vote.

Doesn't get any tighter.

It could in 1817.

I don't think either side thought it was going to be that tight, but it was.

You know, the business community wins on this vote.

Well, I mean, what made the difference this time?

Every session there's a tort bill.

Well, I think, you know, every session there is a tort bill.

And really, I think just the the argument that we see what's going on all across the country, states that aren't taking care of their businesses, which are the job creators, which which are people work for, Right.

You got to have somebody you go to work for, right?

They provide you these good jobs.

States that aren't taking care of their business community are losing the jobs.

They're fleeing to states like Arkansas.

So we have to be we have to recognize that and say, look, we want to be a state where job creators come in that in jobs, follow those.

And that's good for that's good for the working class family.

That's good for the mom and dad.

It's good for the kids.

Obviously, you voted with the majority senator, but 17 of your members, though, evidently sided with the argument that this is not going to be beneficial to the little people at all.

It will argue it will all go against them.

You know, I will tell you, the trial lawyers are very persuasive and they're very good at their job.

Right.

And they've made some very strong cases.

And look, I listened to the debate today.

Look at it.

And I understand my colleagues on why they voted no.

Just at the end of the day, I know how important it is to continue to tell businesses we want them to come to Arkansas.

We're making a business friendly environment because we want good create jobs for the people that live and work here.

Of course, it's early and it's a month, but it's still early in the session.

And the the political climate, the temperature would seem to suggest that the administration is likely to get whatever it wants and certainly whatever, with overwhelming majorities, veto proof majorities in both chambers that you're conference's respective are likely to get substantially what they want.

Or am I off?

Well, you're not off, but I would like to say the governor is getting what she wants because she's smart.

She works with the legislature on what she wants.

We develop a plan that we all can agree on.

One of those things is a cell phone bills and a bell to bill, cell phone bill in schools that we think is going to be really important in Arkansas, leading the nation in that issue.

Well, let me come back to that to that point later, if I may.

One thing that evidently some of her critics in the legislature say she did not work very closely with, and that's the prison in West Arkansas.

That's in your proposed prison.

That's in your quadrant of the state anyway.

What's the outlook there?

Well, look, I would argue differently.

The governor and the legislature has been very transparent since she was elected.

We're going to build a prison.

We've set aside money for it.

We've talked about the process.

We've talked about the type of prison we needed.

So we've been very open.

The governor and her staff were very open about the areas they were looking at.

But look, yes, the one thing they didn't say was this address.

But that's a learned behavior, though, right?

Like a learned lesson, Not necessarily behavior anywhere in the country.

If you say we're building one here, the pressure becomes too great and you end up not getting a prison.

And we have to have a prison term at.

Some of your colleagues there argue that the cost estimate on the administration's part was woefully underestimated in a way that it could be as much as three times the expense for just for the capital outlay.

Sure.

Well, you know, that's very hard for them to argue that because the administration has never had a cost estimate, has never put one fourth, never said about what it would cost.

I've only heard the the people opposed to this prison saying we're out of budget.

Well, the estimates were I was in the neighborhood of 400 to $500 million an and its opponents say no.

I mean, based on estimates from similar projects in other states, it could be thrice that amount.

Sure.

Well, how we how we arrived at that number was a few years ago.

We had significant budget surpluses.

And we decided as a legislature, because we were near in the prison, we were very transparent about it.

We set aside $300 million for that prison.

That was just a first set aside out of some surpluses that we had then we were going to do in addition to a prison, a done there spot of Arkansas.

We had $170 million set aside for that.

Couldn't do that addition because of some sewer utility concerns.

So we moved that money over to the to the big additional prisons.

So we went from 300 to 470.

That's how we got to that number.

That was never a this is the budget number we're working from.

Well, from this from this point, this date is a prison, a done deal.

And that location, the prison is a done deal.

That location, as far as my opinion, is a done deal.

Okay.

Medicaid expansion now a big step on the part of the state.

Are you satisfied that this time it will pass legal or judicial review?

I do feel like we will continue on with with the Medicaid expansion in Arkansas.

Look, it's very difficult to roll things back, but I think any time you're going to be giving somebody something for free, I think you have to you have to understand that.

Okay.

We'll start that question over.

I think the time that I misspoke, Senator, on that, the work requirement and I mentioned to serve the administration has accepted the expansion.

That's right.

On the work requirements.

The people of Arkansas are a very generous people.

We want people that are absolutely in need to to to be able to get help.

But we also think if you can work, you should be working.

I think that is a bipartisan position.

People don't want to be working and paying for somebody that's not working or not even attempting to work.

So these work requirements aren't as difficult as they look.

We want you to be working or trying to work or trying to educate yourself that we will help you educate yourself to get a job.

There is some concern among providers, Senator, that the work requirement, even if it is held to a minimum, could have a pretty deleterious effect, particularly in rural areas of the state on small hospitals, clinics, other providers.

Your thought?

Well, I think that's the.

I think that's absolutely possible.

Right.

Look, we have to take care of our rural hospitals.

But I think if if that needs to happen, it needs to be on an understanding of what we're doing.

If we need to subsidize them in some way because we look, we need hospitals in rural Arkansas if we're going to if we're going to do that by just writing an annual check or if we're going to do that by running it through Medicaid, that's a decision that we want to make.

I'm comfortable making those decisions.

I just want to be as wide open when we do it as as the session ended for the week, in a way at least on on the Senate side anyway.

The administration, the governor unveiled her program for maternal care.

Your first thoughts on it?

My first thoughts are Here's Governor Sanders.

Tackling another difficult issue where Arkansas has been at the bottom of the pile for a long time.

I'm proud of her for continuing to lead.

She's leading on the difficult issues and they're difficult.

We're at the bottom of the pile because they are hard right now and we haven't taken the time or focus to get Arkansas from the 45th or 50th state in this issue.

She's taking on another tough issue.

We're going to see real results.

Well, at first glance around, I just had a moment to review it.

It appears that she is not including what Mr. Pilkington, Representative Pilkington has long advocated rather forcefully, and that's an expansion of the Medicaid program for post-natal ill delivery for one full year.

Would you advocate that?

I mean, would you support that?

Would you advise the governor to think that through again?

Well, I'd absolutely advise the governor in making sure that that our that our moms are being taken care of.

And that could be meaning that we're going to do it through one more one additional year after birth of Medicaid and it could be through some other form.

Look, one thing I appreciate, Governor Sanders, is he always has a creative way of doing something.

So I will lean on her to make sure we're taking care of our moms.

It may not be necessarily through Medicaid.

Lean.

How now are we?

Sure.

Okay.

Well, that's great.

I'll tell you at least once a week.

I have a, you know, one on one meeting with the governor.

We talk through all these issues or how we don't have to do it in the in the paper.

But look, I know what's important to Arkansas, know what's important to the governor and what's important to this legislature.

Taking care of our moms and our babies are it.

And when the members are understand taking care of mom from birth to one year is part of making that successful, We're going to do that.

Okay.

Two weeks ago in that very chair, your counterpart on the on the other end of the Capitol, the speaker suggest that he thought the governor might be willing to accept that expansion.

You're in that very one, we think be the thing, if that's what the governor wants to do.

And that's what the speaker wants to do.

I will tell you that that's two thirds of the way right with it within leadership.

But, you know, I don't know exactly how that's going to go.

Again, it very well may be the case.

We'll see what happens.

But the economy remains strong and collections pretty well reflect that anyway.

Even with the tax cuts, you're going over expectations anyway, with the exception this past month of sales tax revenue with the state's anticipated outlays.

Are you concerned at all about the revenue with with the learns that coming up, the expansion about to take effect?

Well, you know, that's what we're always concerned about the budget, right?

That's why we're that's why we're not leading the session with with more income tax cuts.

We're going to wait yet closer to the end of session or closer to the end of our fiscal year, which is in June before we cut more taxes.

Governor, she was elected by the people on saying that she wanted to work towards a 0% income tax rate.

We've been doing that and while we're doing that, as you just said, we continue to have increased revenue and surpluses.

I suspect we'll have 250 to $300 surplus again this year.

Even with all the cuts.

And what I would say more importantly, continue to provide the services the people of Arkansas expect.

Well, she's she's estimating 300, I believe, $300 million.

Right.

Under $300 million at the end of the fiscal realistic.

I think I think it's very realistic.

And look, here's one thing we've always seen since I've been in the legislature for 12 years, the governor's office and the FAA are very conservative on the number.

We usually say 250 or 300 million the day you get out of session.

That number, that number grows because they don't want members to think we have half a billion dollars or something and want to spend that money.

I don't know that that's happening.

I'm just saying that's the case over about 12 years as far as income or grocery, this year, I, I suspect we will do income tax cuts and I suspect we will do grocery tax cuts.

I suspect we'll do the grocery tax cut in this session and we'll cut income taxes in a special session.

Okay.

You're a former Razorback, so this is, you know, a straight answer now.

All right.

Opening season for the only sport that really matters, right?

Is is a week from today.

So your outlook for the season?

Well, look, I've never seen a team.

If you just look at those guys, even on TV or something, they look like a bunch of action figures out there.

I mean, these guys are specimens.

They're doing special work.

I suspect we will be in Omaha and I hope we bring home a title this year.

Mr. President, thanks for coming in.

As always.

Come back soon.

Thanks for having me.

Okay.

We'll be back in just a moment.

And we are back almost a dozen years ago or approaching that under Governor Asa Hutchinson.

Arkansas was the first state to establish a work requirement to receive Medicaid benefits.

The first Trump administration approved the rule, but it was soon enough struck down in the courts.

Now, the second Trump administration is expected to approve a new the program requested by Governor Sarah Sanders.

Although challenges in the courts and perhaps on Capitol Hill are guaranteed.

Joining us now, Christie Putnam, secretary of the Arkansas Department of Human Services, and Janet Man, who is director of Arkansas's Medicaid program.

Thank you both very much for coming aboard the broadcast to either or.

Secretary Putnam, we'll begin with you.

What what is different from this version, from the one that was tried in in 1920 18?

Sure.

And thanks for having us on, Steve.

So the there are a couple of key differences.

One, major differences that we are not making a work requirement, a condition of eligibility.

You know, it is something that participants can participate in and continue to be active in their qualified health plan, their coverage, instead of dis enrolling them for not participating.

Their benefits would be suspended.

So they would still be eligible for Medicaid.

They would still show is eligible for Medicaid, but they would be suspended from their qualified health plan benefits.

And so that is one of the key differences.

Deputy Mann, would you like to expand on that?

Thank you.

So I think another key difference is lessons learned from the fast work requirement was on the reporting and the communications.

So in this waiver amendment, we are going to exercise lots of technology for matching of community activities and worker in work options and then try to work with the beneficiaries and not have them have a monthly reporting option, which was reported back to us as as heavily burdensome.

In addition, I think the communications with the beneficiaries in various forms via telephone, social media, text, email would be more beneficial this time around than what we had used previously.

Yeah, the execution of this, the screening process in in 2018 was widely faulted by many consumer advocates anyway.

What changes have you made?

What guarantees do the recipients have that their voices will be heard, that their information will be recorded accurately?

So that's one of the things that we've we've tried to address in this waiver amendment is working with data and then working with our sister agencies and community partners in really using the local touch of what are beneficiaries doing every month, every six months or annually.

But then the best thing about this waiver amendment is we have approached the concept data matching and working with our partners in the local communities and then to fine tune the details, we will negotiate with the Trump administration for those terms and conditions in this waiver amendment.

Well, a core issue in any and in a work requirement situation would seem to be as much philosophical, both philosophical and fiscal, in terms of whether this is, you know, a program that should be means tested the way the state is proposing to do.

Secretary Madam Secretary, so is means test is different from applying a work requirement.

We have a number of means tested or income based programs that already have a component of a work requirement.

SNAP has a requirement for able, able bodied adults without children to to have some sort of qualifying work or education activity.

The Temporary Assistance for Needy Families Program or Tanaiste also has a component.

So really Medicaid is an outlier in this regard and we are viewing it as you know, it's something that can be streamlined to complement the other programs that have a work component to them.

And we're looking for ways to find efficiencies so that we can leverage resources across all of these programs really to encourage individuals to engage in some sort of an activity that's not going to be just a job.

I think that's a big delineation that we'd like to make, is we don't want this to be just a job.

We want it to be a career path for individuals.

So I think that's one of the big differences.

It's not just a means tested.

Means tested is income.

This is a work component that already exists in many of our other programs.

How many present recipients would you estimate do you have?

What do you think is a firm estimate or a good estimate of how many individuals would be immediately involved or affected?

We do not.

So in this proposal, we are proposing the entire population in the made in the Medicaid expansion population, which is 19 to 64, they're currently about 220,000 individuals enrolled, and that changes every month.

So we will be working with all of them to work on this community engagement and work requirement.

But we have not drawn any estimates as we are waiting on public comment so that we can submit to CMS and then begin negotiations.

So is there a sense of or an estimate of the overall fiscal impact then?

No, sir.

Without being able to estimate the eligibles, we cannot apply and fiscal impact to that.

But we do know that people are happier and healthier when they're they are going to work and they have better mental health outcomes when they are either seeking community engagement or a work opportunity.

So that's what we're hoping to see, is one of the outcomes in addition to maybe better opportunities for their careers.

Yes.

On the fiscal impact, you know, I think there is a tendency to focus on the fiscal impact of people no longer being part of the Medicaid program and what what kind of savings is there.

But I think it's important to look at the flip side of that.

If people are moving out of Medicaid eligibility because they have gotten a job that is a really a living wage and they're qualifying for employer based insurance, they are now making more.

And there's a positive fiscal impact to the state overall because they are taxpayers, they're contributors, They're they're out in their communities.

And so I think, you know, focusing on both aspects of fiscal, you know, fiscal impact here is really critical.

And that is why we named it Pathway to prosperity in terms of fiscal impact, the immediate fiscal impact, could it not be a would be to providers, particularly providers in rural areas where they're already the margins are pretty thin.

So I think, you know, that is part of what we will be working through for implementation purposes is that we do intend to leverage a support network and it is very much about engaging with the community level resources that already exist to make sure that those individuals are not simply disconnected from coverage, but they move into a different coverage.

And so if someone moves from Medicaid coverage into commercial insurance that sponsored by, you know, an employer or even that's a marketplace plan that they've purchased with a subsidy from the federal government, those commercial plans actually pay providers a better rate.

So in the end, providers could stand to be better off with this approach.

What what what is the concern or level of concern, if that's the term that a great many individuals who will start going to emergency rooms for treatment as opposed to just routine general pediatric care or general practitioner care.

So I don't think we have factored in any type of outcomes based of anyone that would move from Medicaid covered insurance to a different type of insurance.

We do think it will be a net neutral to the communities if they have Medicaid coverage and they move to an employee sponsored coverage and it would make them more active in the community to make estimates on a potential impact to an ER versus a provider.

We have not done that.

Is that analysis Will there be any kind of structure or a network to provide services like child care or transportation for for recipients who will enter the program?

So that's part of the leveraging existing resources that we will work on building out as we go through the planning and implementation phase, both with our our team here at DHS and sister agencies and also with the Center for Medicare and Medicaid Services.

There are options already available for child care and transportation.

There are there are gaps, and we know that there are gaps in both.

But it would be making sure that people get connected to what does exist.

And then, of course, considering extenuating extenuating circumstances where an individual does not have that access is something that would be considered for, you know, are they are they do they need to have a pause of that requirement that they have?

As I understand it, the program will not be fully operational anyway until next calendar year anyway, or a calendar or a fiscal Either way, what be what's the delay here?

Just approval for CMS.

Yes, sir.

So there's we have a 30 day public comment period going on right now at the state level.

That's a requirement through state law.

Those public comments will be answered and then packaged with the waiver and submitted to CMS.

CMS will do an additional 30 day comment period at the federal level.

Then we will begin negotiations to finalize the waiver.

And then there are system changes that will have to go into place and then there will be an entire outreach and communications plan.

So really the goal of one one of 26 gives us the time to plan and have this spread throughout the entire state very thoughtfully and complete.

Let me shift gears, if I can, for just a second.

The governor announced on Thursday a review unveiled on Thursday her maternal care program.

Is this a major breakthrough?

It's a major breakthrough.

It's an exciting it was an exciting day for Arkansas.

So the governor in her budget gave the division of Medicaid 13 million extra dollars.

And with the matching with the federal government, we can turn that into $45 million annually.

And we're going to use that to pay providers better for deliveries in C-sections.

And regular deliveries also pay for additional office visits and lab work and things that they need.

The whole goal here is prevention.

Have a healthy mom and have a healthy baby.

So by moving upstream and trying to open up access to care, then pregnant moms across the state can have better care.

In addition, we're going to implement presumptive eligibility for pregnant women, and that is a short term option for when pregnant women find out they're newly pregnant, they can go to the doctor while they're working on their Medicaid application and then not have a break in their care.

So we are very excited for this.

This has been almost a year.

The governor signed an executive order in March.

The maternal Health Committee was created and produced recommendations in September, and now the very 1st of February.

We are looking at legislation to put those recommendations into place.

And that is not all that's been done.

There's been several other areas of education and outreach done and data and reporting.

And so we're just getting started.

We've got just a few seconds remaining, but I would note that it does not include the one year extension of Medicaid for postpartum care.

It does not.

Does not, because we Arkansas already has coverage for women once they move past the 60 day postpartum period.

So what it does include is additional outreach methods for us to work with women during that 60 day postpartum period to make sure that they're connected either to Medicaid if they're eligible or to another version of coverage in the state.

But we do already have coverage for that.

Got to end it there because we are simply out of time.

Madam Secretary, Madam Director, thank you very much for being with us.

Thank you for your time.

Come back soon.

Thank you.

Thank you.

And that does it for us for this week.

As always, we thank you for watching and see you next week.

Support for Arkansas Week provided by the Arkansas Democrat-Gazette, The Arkansas Times and Little Rock Public Radio.