Arkansas Gov. Asa Hutchinson (R) on Monday announced proposed changes to the state’s Medicaid expansion program that would dramatically reduce health-care access for the state’s low-income families. 

The governor’s proposal would lower the income requirement for Medicaid eligibility from 138 percent of the federal poverty level to 100 percent. That change would reduce the income cutoff for an individual from $16,643 to $12,060, and reduce the income cutoff for a family of four from $33,948 to $24,600.

If Hutchison’s amendments are approved by the federal government, around 60,000 Arkansas residents enrolled in Medicaid would no longer be eligible for the program.

The Republican governor said during the press conference that the proposal would only shift people from Medicaid to the federal health insurance exchange and the individual marketplace. “It will not deprive those that are in that category of health-care coverage,” Hutchinson said. “It will just simply shift them if they’re above the federal poverty level toward the individual marketplace.”

More than 310,000 people are enrolled in Arkansas’ Medicaid program, according to statistics released by the state.

The governor’s proposal would establish a work requirement for non-disabled adult Medicaid users, similar to the work requirement of the federal Supplemental Nutrition Assistance Program. The plan also seeks to “encourage people who earn between 75 percent and 100 percent of the federal poverty level and work for a small business to move to employer-sponsored insurance,” according to the Arkansas News Bureau.

Another change would make Arkansas an “assessment state,” which would give the state—instead of the federal government—control over determining the eligibility of Medicaid applicants.

 

Arkansas is one of a handful of states that received approvals during the Obama administration for alternative programs for Medicaid expansion under the Affordable Care Act (ACA). Arizona, Indiana, Iowa, Michigan, Montana, and New Hampshire all received waivers for hybrid Medicaid expansion, which have often included a so-called private option.

The program, now known as Arkansas Works, provides government-subsidized private health-care insurance for people with low incomes, unlike the traditional Medicaid program that provides health insurance through the state.

Arkansas saw significant increases in health-care access for low-income residents after implementation of the ACA. The uninsured rate in Arkansas dropped from 22.5 percent in 2013 to 9.4 percent by 2015, according to Gallup polling.

Hutchinson’s proposed changes come as the GOP-controlled U.S. Congress debates how to repeal and replace the ACA, which was a campaign promise of both U.S. President Donald Trump and congressional Republicans.

The proposed replacement plan introduced by Republicans in the U.S. House would end the the ACA’s Medicaid expansion by 2020.

Hutchinson told reporters during Monday’s press conference that he did not intend to wait for Congress, reported the Associated Press. “I don’t think we can wait on the federal government,” Hutchinson said. “I think we need to continue our reforms now.”

The governor said that he plans to submit the waiver amendments to the Trump administration for approval by June, and that he hopes the changes would take effect in January 2018.

“I have spoken with Secretary Price and the Trump Administration about our plans to file these waiver amendments, and they’ve conveyed to me that the requests are consistent with the overall objectives of reform efforts in Washington,” Hutchinson said in a statement.

Hutchinson said during the press conference he plans to call a special legislative session for state lawmakers to take up the proposal.

Arkansas Senate President Pro Tempore Jonathan Dismang (R-Searcy), who joined the governor during the press conference, told the Arkansas Democrat-Gazette that Hutchinson’s proposal was a “great step in the right direction.”

Expressing skepticism, senate Minority Leader Keith Ingram (D-West Memphis) told the Arkansas News Bureau that he would like more information about how the changes would affect Arkansas families with low incomes. 

“We’ve come so far in cutting our uninsured to historic lows. I’d hate to do anything to jeopardize that,” Ingram said.

Robin Rudowitz, associate director at the Kaiser Family Foundation’s Program on Medicaid and the Uninsured, told the Arkansas Democrat-Gazette that Hutchinson’s proposed changes were announced while there is still much uncertainty about the fate of the ACA and the Republican replacement plan.

“This is coming at the time when, of course, there are these larger discussions about whether there will be tax credits and whether there will be marketplaces, and the larger issues around [the Affordable Care Act],” Rudowitz said. “All of these things are a topic of heated debate as we speak.”