Joint legislative panel approves Medicaid expansion appropriation bill; Senate vote expected Tuesday

A joint legislative panel on Monday let go of several key appropriations bills necessary to fulfill Gov. Asa Hutchinson’s $5.44 billion budget for fiscal 2019, including legislation for a long-awaited Medicaid waiver that was celebrated hours earlier by Gov. Asa Hutchinson and the top official at the federal Centers for Medicare and Medicaid Services (CMS).

Sen. Larry Teague, D-Nashville, co-chairman of the state Joint Budget Committee, subtlety guided approval of House Bill (HB) 1088 and several other appropriation bills through the legislative panel following a heated discussion that often veered off-topic and included verbal jabs between lawmakers over Arkansas Works, the state’s Medicaid expansion program that buys private health insurance for eligible citizens.

At day’s end, the legislative panel made of up senior House and Senate members who work on interim year and fiscal session budget matters, approved the bill that would make Arkansas the first state to require able-bodied beneficiaries of Arkansas Works health insurance to work 80 hours per month or engage in other activities such as job training, job searching, education or volunteering, or some combination of those.

Teague told Talk Business & Politics that he asked Sen. Bryan King, R-Green Forest, to release a procedural hold on HB 1088 after the Northwest Arkansas Republican employed a parliamentary tactic that allows one or more JBC committee members to prevent a motion from reaching a full vote on either the House or Senate floor.

“I convinced him to let it (HB 1008) go, and then he can fight it out on the Senate floor,” Teague said. The Democratic budget hawk and Sen. Jim Hendren, R-Gravette, said they expect the bill to be taken up by the full Senate on Tuesday, where it likely faces stiff resistance from several Republican senators who see Arkansas Works as an unaffordable expansion of government.

“I still expect it to be on the floor (tomorrow),” said Hendren, who was chosen by the Senate Republican caucus last week to be the next Senate President Pro Tempore.

27 SENATE VOTES NEEDED
Under legislative rules, 27 senators and 75 representatives must vote for all appropriations. That includes the state Department of Human Services (DHS) appropriation that contains the Medicaid expansion funds. In past sessions, opponents have tried to kill the program through the appropriation process.

In the 2017 regular session, DHS’ appropriation failed twice in the Senate and the House. It finally passed with the minimum 27 votes in the Senate, with seven not voting and King voting no. The House passed it 77-13 with 9 not voting and 1 voting present.

In the JBC meeting after the House and Senate convened Monday afternoon, King first told Teague he would keep his hold on HB1088 until Tuesday or when state Department of Human Services Director Cindy Gillespie came before the joint budget panel and answered several questions he had about growing Medicaid costs and other matters of fiscal concern.

“I just want some answers. A (standing) senator shouldn’t have to FOI (Freedom of Information) a state director … to get them to respond to their questions,” King told the joint committee.

After complaining of the DHS director’s lack of responsiveness, Sen. Missy Irvin, R-Mountain View, testified that that Gillespie and other DHS officials had provided ample information concerning the Medicaid waiver and Arkansas Works in committee meetings and other legislative forums. Not speaking to King directly, she said “any senator” could voluntarily attend those meetings to get their questions answered.

Irvin’s response caused King and other lawmakers to engage in a heated back-and-forth concerning Arkansas Works and other financial matters until Sen. Linda Chesterfield, D-Little Rock, interjected and asked the lawmakers to “be civil.”

Soon after, the joint legislative committee removed holds on HB 1088 and several other key appropriation bills after Teague convinced King and other lawmakers that the panel needed to move forward for the General Assembly to end the 30-day session next week. The off-year session, which is held every two years, must end by March 13 unless there is a three-fourths vote to extend it an additional 15 days.

Hendren, Teague and several other lawmakers and policymakers polled by Talk Business & Politics said they expect tomorrow’s Senate floor vote on HB 1088 to be very close. As of today, there are only 33 senators seated with 27 votes necessary for all appropriation bills.

Sen. Eddie Joe Williams, R-Cabot, who voted for the appropriation last year, resigned to work for the Trump administration. Sen. Greg Standridge, R-Russellville, who was recorded as not voting, died after the session. Sen. Jake Files, R-Fort Smith, resigned after pleading guilty to wire and bank fraud. Special elections to replace them will not occur until after the session ends.

Two weeks ago, Gov. Hutchinson told reporters he will call lawmakers back to the State Capitol immediately after the ongoing fiscal session to pass legislation to address growing concerns on rising health costs associated with so-called PBMs, or pharmacy benefit managers. However, the governor said the session will only start if Senate President Pro Tempore Jonathan Dismang, R-Searcy, and Speaker of the House Jeremy Gillam, R-Judsonia, and other legislative leaders can find a two-thirds consensus of the full General Assembly to speedily approve the PBM proposal and clean-up legislation on open containers of alcohol in motor vehicles.

Earlier in the day, Seema Verna, CMS administrator and the chief architect of Indiana’s redesigned Medicaid program under Vice President Mike Pence, signed the Medicaid waiver and gave it to Gov. Asa Hutchinson during an overflow press conference at the Governor’s Conference Room. The Trump administration is still considering the state’s request to lower the income eligibility to 100% of the federal poverty level.

If HB 1088 is approved by the Senate and House, Arkansas DHS officials will immediately begin phasing in the program, beginning with recipients ages 30-49 this year. Next year, recipients ages 19-30 will be required to work or engage in work-related activities.

The waiver will affect 39,918 beneficiaries this year, said DHS spokesperson Amy Webb. The state has 99,632 recipients ages 30-49, but 59,714 qualify for an exemption. Exempted beneficiaries include those who are medically frail, those who are pregnant, those who face a short-term incapacitation or are caring for an incapacitated person, and others. Arkansas Works covered about 286,000 Arkansans as of the beginning of the year.