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Committee considers waiver redesign to let Arkansans age in place but fails to advance bill
Summary
Sponsor and home-care advocates asked DHS to redesign Arkansas' HCBS waivers so beneficiaries could age in place when possible while meeting federal budget-neutrality requirements; proponents argued the current gap between home-based caps and nursing-home costs creates avoidable institutionalization.
Sen. Clint Penzo and home-care advocates presented SB306, a legislative request for the Department of Human Services to redesign Arkansas pproach to home and community based services (HCBS) so that, when feasible and budget-neutral, beneficiaries could remain at home rather than entering skilled nursing facilities.
John Burris of the Home Care Association told the committee the bill implements recommendations from the independent Medicaid sustainability report and called for setting legislative goals or "bumper rails" to let DHS and CMS design specific waiver changes. Burris said the current gap is wide: recipients on the HCBS waiver typically cap out at $34,000 per year while average skilled-nursing costs are about $102,000 in Arkansas.
Opposition testimony came from the Arkansas Healthcare Association. Executive Director Rachel Bunch argued HCBS services are not equivalent to skilled nursing: waivers fund nonmedical personal-care services (ADLs, meals, transportation and adult day care) while nursing facilities provide 24/7 skilled clinical care, licensed nursing staff, pharmacy and other mandated services. Bunch submitted a CPA analysis (handout) estimating the change could raise general-revenue costs by up to $223 million per year if implemented without design limits.
DHS said it was neutral and explained it could not provide a single fiscal-impact number because the waiver is due for renewal next year and many design options exist; the agency said budget-neutrality (statutory and CMS rules) must be met for any waiver. DHS provided historical waiver spending data and said it lacked a design on which to base a defensible fiscal estimate.
Senators debated the comparison between HCBS and institutional services and asked DHS whether budget-neutrality provisions in federal waiver rules would prevent increased state costs. The transcript records a vote in committee that resulted in more "no" than "yes" votes; senators recorded the tally in a roll call and the clerk announced the bill failed.
