Feds OK Arkansas’ Life360 model incentivizing health outcomes

The federal government on Tuesday (Nov. 1) approved Arkansas’ waiver request to incentivize insurers to improve health outcomes for at-risk pregnant women and others through services offered by hospitals.

The Life360 Homes model is meant to address maternal health, mental health, and young adults at risk of long-term poverty.

It is part of Arkansas Health & Opportunity for Me, or ARHOME. That’s the latest version of the state’s Medicaid expansion under the Affordable Care Act, otherwise known as Obamacare. The program served 339,297 adults as of Sept. 1.

Under the Life360 Homes model, the state will provide government dollars to insurance companies to cover services coordinated by hospitals. Insurers will face still-to-be-determined sanctions, including a loss of funding, if patients they cover fail to meet certain targets set by an advisory panel.

In a press conference announcing the waiver approval by the Centers for Medicare and Medicaid Services, Gov. Asa Hutchinson said the program is meant to improve health outcomes for vulnerable populations and reduce the overall costs of health care.

The program will cost approximately $16 million and will be funded along an 80-20 split, with the federal government paying $13.6 million and state government responsible for $3.2 million.

For high-risk pregnancies, the program will provide home visitation services through a Maternal Life 360 Home, which is a birthing hospital that contracts with a home visiting provider. The service will be available through birth and for up to two years afterwards.

In 2021, 12,500 women on Medicaid were diagnosed with having high-risk pregnancies. Hutchinson noted that Arkansas has among the nation’s highest maternal mortality and infant mortality rates.

Meanwhile, through the Rural Life360 program, rural hospitals will provide care coordination services for individuals with a serious mental illness or a substance use disorder for up to two years. Community screenings for health-related social needs will be provided. The hospitals also will receive funding to operate an acute crisis unit.

Success Life360 will support at-risk young adults who are most at risk of long-term poverty through acute care hospitals. Those will include individuals previously in foster care ages 19 to 27, which currently includes 5,700 ARHOME clients. Also served will be the 750 young people who were formerly incarcerated and are ages 19-24; the 800 individuals ages 19-24 who formerly were in Division of Youth Services custody; and veterans ages 19-30.

Hospitals will contract with community organizations that serve clients with health-related social needs including housing, education, applying for jobs and obtaining a driver’s license. Services will be provided for up to 24 months or until individuals age out of their eligibility.

Sen. Missy Irvin, R-Mountain View, who sponsored the legislation creating the Life360 models, said policymakers studied the program’s clients and their needs.

“It’s really trying to reshape and focus the policy to where we bring all the services, much of which are already available to them, but bring it in a more intentional, focused way to really achieve a better outcome for that person and that individual, and for that baby particularly,” she said.

The program is the latest version of what originally was known as the “private option.” After the Affordable Care Act was signed into law in 2010, the U.S. Supreme Court declared unconstitutional the part of the law requiring states to expand their Medicaid populations. It ruled that states could choose to participate.

Arkansas in 2013 applied for a waiver to expand its population to individuals with incomes up to 138% of the federal poverty level, but instead of simply expanding Medicaid, it used those mostly federal dollars to buy private insurance for those adults.

While the program enjoyed support from a majority of legislators, others were opposed and tried to end it by voting against funding the agency that administers it. Funding bills require a three-fourths majority, a high bar.

The program has undergone several changes under Hutchinson’s leadership, including a request for a work requirement that was struck down by a federal judge in 2019. At the time, the program was known as Arkansas Works.

Hutchinson on Nov. 1 called the program “an Arkansas success story” that had improved health care access and controlled costs. He noted the program passed easily in the most recent legislative session and continues to have legislative support.

“It’s part of the fabric of our health care systems now,” he said. “I think it is an important success story, but we’ve got to do better. And that’s why this initiative calling upon our insurance companies not just to provide insurance and pay bills, but to actually engage in improving health outcomes and holding them accountable for it is so critical.”