Obamacare in Arkansas

Health Insurance Marketplace in Arkansas

If you live in Arkansas, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov.

Health Insurance Marketplace in Arkansas

If you live in Arkansas, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the Arkansas insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Arkansas will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Arkansas 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)?

Get local help

Southern United Neighborhoods

Southern United Neighborhoods (SUN) is a public charity founded in March 2010 by low to moderate income people that uses research and training to combat the poverty, discrimination and community deterioration that keeps low income people from taking advantage of their rights and opportunities. Southern United Neighborhoods’ Tri-State Outreach Project will implement and fulfill Navigation duties in the Tri-State Region of Arkansas, Louisiana, and Texas in Public-Use Microdata Areas (PUMAs) with high considerations of low income uninsured adult populations.

University of Arkansas

The Arkansas Navigator Coalition is based out of the University of Arkansas, and plans to reach out to areas of Arkansas with the highest level of uninsured. The Coalition is comprised of agencies serving young adults, Latinos, African Americans, persons who are homeless,
mentally ill, living in poverty, or who have disabilities.
Who you can contact for more help?

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.

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Accountable Care Organizations in Arkansas

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

• Christus St. Michael Health System AR – Health Care Innovation Award
• Developmental Disabilities Health Services AR – Health Care Innovation Award
• University Of Arkansas For Medical Sciences AR – Health Care Innovation Award
• State of Arkansas AR – State Innovation Models Initiative: Testing Awards

Health care facilities where Innovation Models are being tested

• Fort Smith Physicians Alliance ACO Fort Smith, AR – Advance Payment ACO Model
• St. Vincent Infirmary Medical Center Little Rock, AR – BPCI Initiative: Model 2
• CareLink AR – Community-based Care Transition Program
• St. Vincent Family Clinic – Rodney Parham Little Rock, AR – Comprehensive Primary Care Initiative
• UAMS Family Medical Center Springdale Springdale, AR – Comprehensive Primary Care Initiative
• UAMS AHEC Southwest Texarkana, AR – Comprehensive Primary Care Initiative
• UAMS AHEC Northeast Jonesboro, AR – Comprehensive Primary Care Initiative
• Dr. Andy’s Family Practice PLLC Mountain View, AR – Comprehensive Primary Care Initiative
• Harrison Family Practice Clinic Harrison, AR – Comprehensive Primary Care Initiative
• Barry V. Thompson, M.D. Crossett, AR – Comprehensive Primary Care Initiative
• Bryant Medical Clinic Bryant, AR – Comprehensive Primary Care Initiative
• Saline Med Peds Benton, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Perryville Perryville, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Arkadelphia Arkadelphia, AR – Comprehensive Primary Care Initiative
• UAMS Area Health Education Center West Fort Smith, AR – Comprehensive Primary Care Initiative
• St. Vincent Family Clinic – Chenal Little Rock, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Malvern Malvern, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Maumelle Maumelle, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic West Little Rock, AR – Comprehensive Primary Care Initiative
• Beebe Family Clinic Beebe, AR – Comprehensive Primary Care Initiative
• Benton Family Clinic Benton, AR – Comprehensive Primary Care Initiative
• Autumn Road Family Practice Little Rock, AR – Comprehensive Primary Care Initiative
• B. Brooks Lawrence, M.D., P.A. Conway, AR – Comprehensive Primary Care Initiative
• Covert Clinic, PA Ashdown, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Baptist Health Drive Little Rock, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Bryant Bryant, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Cabot Cabot, AR – Comprehensive Primary Care Initiative
• Clopton Clinic Jonesboro, AR – Comprehensive Primary Care Initiative
• SAMA Healthcare Services El Dorado, AR – Comprehensive Primary Care Initiative
• Klepper Harrison, AR – Comprehensive Primary Care Initiative
• Senior Health Clinic West Memphis, AR – Comprehensive Primary Care Initiative
• Shipley and Sills Family Doctors Fort Smith, AR – Comprehensive Primary Care Initiative
• Batesville Family Practice Clinic Batesville, AR – Comprehensive Primary Care Initiative
• UAMS AHEC-NW Family Practice Residency Program Fayetteville, AR – Comprehensive Primary Care Initiative
• West Shores Medical Clinic Hot Springs, AR – Comprehensive Primary Care Initiative
• Bradley Bibb MD PLLC Ash Flat, AR – Comprehensive Primary Care Initiative
• Michelle Weaver M.D. Warren, AR – Comprehensive Primary Care Initiative
• Fountain Lake Family Medicine Hot Springs, AR – Comprehensive Primary Care Initiative
• John E Alexander Jr MD PA Magnolia, AR – Comprehensive Primary Care Initiative
• Internal Medicine Diagnostics Inc Cherokee Village, AR – Comprehensive Primary Care Initiative
• Ozark Internal Medicine and Pediatrics Clinton, AR – Comprehensive Primary Care Initiative
• Ouachita Valley Family Clinic Camden, AR – Comprehensive Primary Care Initiative
• Mercy Clinic Internal Medicine Rogers, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Hillcrest Little Rock, AR – Comprehensive Primary Care Initiative
• Conway Family Medical Care, PA Conway, AR – Comprehensive Primary Care Initiative
• Dewey R McAfee DO PA Beebe, AR – Comprehensive Primary Care Initiative
• Baptist Health Family Clinic Lakewood North Little Rock, AR – Comprehensive Primary Care Initiative
• Family Clinic of Ashley County Crossett, AR – Comprehensive Primary Care Initiative
• Washington Regional Clinic for Senior Health Fayetteville, AR – Comprehensive Primary Care Initiative
• Tilley Diagnostic Clinic Malvern, AR – Comprehensive Primary Care Initiative
• The Leslie Clinic, PA Harrison, AR – Comprehensive Primary Care Initiative
• St. Vincent Medical Group Longevity Center Little Rock, AR – Comprehensive Primary Care Initiative
• Siloam Springs Medical Center Siloam Springs, AR – Comprehensive Primary Care Initiative
• Sherwood Family Medical Center Sherwood, AR – Comprehensive Primary Care Initiative
• Bryant Family Practice Bryant, AR – Comprehensive Primary Care Initiative
• Randy D. Walker, M.D., P.L.L.C. De Queen, AR – Comprehensive Primary Care Initiative
• Burchfield Family Medicine Paragould, AR – Comprehensive Primary Care Initiative
• Greenbrier Family Clinic Greenbrier, AR – Comprehensive Primary Care Initiative
• West Washington County Clinic, P.A. Lincoln, AR – Comprehensive Primary Care Initiative
• St. Vincent Medical Clinic Midtowne Little Rock, AR – Comprehensive Primary Care Initiative
• Cowherd Family Medical Center Heber Springs, AR – Comprehensive Primary Care Initiative
• Glenwood Family Medicine Glenwood, AR – Comprehensive Primary Care Initiative
• Garner Family Medical Clinic Hardy, AR – Comprehensive Primary Care Initiative
• Foscue Medical Clinic Warren, AR – Comprehensive Primary Care Initiative
• Freeman Family Medicine Conway, AR – Comprehensive Primary Care Initiative
• Mercy Clinic Primary Care Lancashire Bella Vista, AR – Comprehensive Primary Care Initiative
• North Central Arkansas Medical Associates Mountain Home, AR – Comprehensive Primary Care Initiative
• Lofton Family Clinic De Queen, AR – Comprehensive Primary Care Initiative
• Little Rock Family Practice – Central Little Rock, AR – Comprehensive Primary Care Initiative
• Little Rock Family Clinic – West Little Rock, AR – Comprehensive Primary Care Initiative
• Verona T Brown, MD Batesville, AR – Comprehensive Primary Care Initiative
• Hamilton West Family Medicine Hot Springs, AR – Comprehensive Primary Care Initiative
• ARcare – 55 Jonesboro, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 16 Bald Knob, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 10 Augusta, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 40 Hazen, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 50 McCrory, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 70 Brinkley, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 80 Kensett, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Corning Area Healthcare, Inc. Walnut Ridge, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Corning Area Healthcare, Inc. Pocahontas, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Mid-Delta Health Systems Inc. Clarendon, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• ARcare – 17 Carlisle, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Pine Bluff Medical Clinic Pine Bluff, AR – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Birth Center of Northwest Arkansas Rogers, AR – Strong Start for Mothers and Newborns Initiative

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Arkansas

On December 12, 2012, Governor Mike Beebe (D) informed federal officials that Arkansas would pursue a state-federal partnership health insurance exchange. A state opting for a partnership exchange can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations or use federal government services. While the Governor acknowledged in November 2012, the possibility of pursing a state-run exchange if the Arkansas Legislature enacted exchange authorizing legislation, the state continues to plan for a partnership exchange.

Arkansas has moved quickly to define its role in a partnership exchange, focusing on maintaining flexibility and control over insurance plan selection, rating, monitoring and consumer assistance functions including, outreach, education, and an In-person Assister program. The Department released a comprehensive framework for the Exchange, noting primary sponsorship and decision-making rests with the Insurance Commissioner. A Steering Committee was also created to authorize resources and provide oversight. The Committee meets monthly and members include senior management from the Insurance Department, the Department of Human Services, Arkansas Health Agency Leaders, Advisory Committee Co-Chairs, the Department of Finance and Administration, the Legislature, and the Governor’s office.

Contracting with Plans: In early 2012, the Insurance Department issued a Request for Proposals (RFPs) for subcontractors to assist with the development of Exchange requirements related to qualified health plan certification. The state has since created a Plan Management Advisory Committee comprised of dozens of stakeholders representing hospitals, insurers, businesses, and consumers.The Committee meets bi-monthly and focuses on the definition and delivery of Qualified Health Plan guidelines. Recommendations from the Advisory Committee are forwarded for approval to the Steering Committee, and then sent to the Insurance Commissioner for approval. In September 2012, the Commissioner approved recommendations that Arkansas not require network adequacy standards that exceed the federal requirements in the first year, that carriers not be required to offer qualified health plans statewide, and that the state may limit the number of plans or benefit designs offered by a carrier.

Consumer Assistance and Outreach: Various consumer assistance and outreach activities are facilitated by the Arkansas Insurance Department and through subcontractors. In early 2012, the Insurance Department began planning for a Navigator program and awarded multiple RFPs to subcontractors to assist with development. Soon thereafter however, the Center for Consumer Information and Insurance Oversight clarified that in a partnership exchange, the Navigator program will be run by the federal government, but all states have the option to develop an In-Person Assister Program. The In-Person Assister program functions similarly to a Navigator program, but can use federal Exchange Establishment grants for development and operation. Over the past few months, Arkansas has focused significant effort on developing an In-Person Assister Program and eventually, hopes to brand both the Navigator and In-Person Assister programs as one, so that to consumers they appear the same.

The state has created a Consumer Assistance Advisory Committee comprised of dozens of stakeholders representing consumers, hospitals, and community organizations. The Committee meets bi-monthly and focuses on developing In-Person Assister (IPA) guidelines, outreach efforts, and consumer complaint resolution. Since May 2012, the Advisory Committee has issued numerous recommendations regarding IPAs including that brokers and producers be allowed to serve as IPAs, that IPAs complete a state training for certification with certain defined competencies, and that the state pay IPA entities using a combination of a contract payment and performance-based payment. Recommendations have been forwarded to the Steering Committee for review.

Coordination with Medicaid: Arkansas plans to interface their Medicaid program with the federally-facilitated exchange. The Department of Human Services (DHS), which includes the state’s Medicaid agency and multiple other agencies, determined the state will use the “Access Arkansas” portal as an Exchange interface. Arkansas received approval from the Centers for Medicare and Medicaid Services (CMS) for enhanced funding to upgrade its Medicaid eligibility and enrollment systems.

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Arkansas Insurance Department accepted Rule 103, which granted EHB-decision-making authority to the Insurance Commissioner. Based on analyses and stakeholder feedback, the Arkansas Exchange sent preliminary EHB recommendations to the Commissioner for review which were accepted. Preliminary recommendations included the small group plan Arkansas Blue Cross Blue Shield Health Advantage Point of Service Plan as the benchmark. Also, the state chose QualChoice Federal Plan Mental Health and Substance Abuse Benefits to meet the federal mental health parity requirement, the Arkansas Children’s Health Insurance Plan (CHIP) for pediatric dental services, and the Arkansas Blue Cross Blue Shield Federal Pediatric Vision Plan for pediatric vision coverage.

 Exchange Funding

The Arkansas Insurance Department received a federal Exchange Planning grant of almost $1 million in 2010. In September 2011, Governor Beebe contemplated applying for a Level One Establishment grant but declined after hearing lawmakers’ objections. A few months later however, the state submitted an application for $7.6 million in federal funding to implement the partnership exchange. In February 2012, the grant was awarded and Arkansas plans to use the funds to design and implement IT systems to connect Arkansas Medicaid and state-run exchange functions to the federally-operated eligibility and enrollment portal, implement systems to support state-operated consumer assistance functions, and develop plan management functions of the Exchange. In September 2012, Arkansas received a second Level One Establishment grant of $18.6 million to work in partnership with the federal government and other state stakeholders to implement plan management and consumer assistance components of the Exchange.

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Arkansas will use an alternate expansion plan. Will accept federal money and use to purchase private insurance for about 250,000 eligible low-income residents.

Next Steps

On January 3, 2013, Arkansas received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-federal partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and maintaining a federal funding source through plan year 2014. The state must also sign a memorandum of understanding with CMS that defines roles and responsibilities for Exchange plan management and consumer assistance, outreach, and education operations by February 15, 2013.

Additional information about Arkansas’ Health Benefit Exchange planning can be found at:http://www.hbe.arkansas.gov/

 

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1. Governor Beebe Letter to Secretary Sebelius. December 12, 2012. http://www.healthcare.gov/law/resources/letters/ar-exchange-letter.pdf
2. DeMillo, Andrew. “Mike Beebe Still Looking at State-run Health Insurance Exchange.” Arkansas Business. November 16, 2012. http://www.arkansasbusiness.com/article/89035/mike-beebe-still-looking-at-state-run-health-insurance-exchange
3. Arkansas-FFE Partnership Stakeholder Engagement Model.http://www.hbe.arkansas.gov/FFE/Steering/StakeholderModel.pdf
4. Request for Proposals. Quality Health Plan Specialist. Arkansas Insurance Department. January 30, 2012. http://hbe.arkansas.gov/RFQ_ID‐12‐0001.pdf
5. See Plan Management Advisory Committee Members:http://www.hbe.arkansas.gov/FFE/Plan/Members.html
6. Arkansas Federally-facilitated Exchange Partnership. September 17, 2012.http://www.hbe.arkansas.gov/FFE/Plan/Recommendations/9-17-2012.pdf
7. Request for Proposals. Navigator Program Consultant. Arkansas Insurance Department. February 13, 2012. http://www.hbe.arkansas.gov/ID-12-0002.pdf
8. Request for Proposals. Navigator Program System Provider. Arkansas Insurance Department. March 8, 2012. http://www.hbe.arkansas.gov/SP-12-0194.pdf
9. Will Rourke. Solicitation of Information For: Navigator Program Integrated Software Solutions. Arkansas Insurance Department, June 1, 2012. http://hbe.arkansas.gov/FFE/RFI-NavigatorProgram.pdf.
10. See Consumer Assistance Advisory Committee Members:http://www.hbe.arkansas.gov/FFE/Consumer/Members.html
11. See Consumer Assistance Advisory Committee:http://www.hbe.arkansas.gov/FFE/Consumer.html
12. Consumer Assistance Advisory Committee IPA Entity Application. August 10, 2012.http://www.hbe.arkansas.gov/FFE/Consumer/CAACPresentationAug2012.pdf
13. Arkansas FFE Partnership Level One Establishment Grant application.http://hbe.arkansas.gov/GrantApp8-14-12.pdf
14. Commissioner Jay Bradford, Insurance Commissioner. Rule 103: Essential Health Benefit Benchmark Plan. Arkansas Insurance Department, June 28, 2012.http://www.insurance.arkansas.gov/Legal%20Dataservices/NOH/NOH-PropRule103.pdf.
15. Arkansas Insurance Department. Selection of Arkansas’ Essential Health Benefits Benchmark Plan. September 21, 2012. http://www.hbe.arkansas.gov/2-2012.pdf
16. DeMillo, A. “Ark. Insurance Officials Look at Health Exchange.” Forbes. October 11, 2011.
17. Level One Establishment grant funding proposal.http://hbe.arkansas.gov/GrantApp12_22_11.pdf
18. Letter from HHS to Governor Beebe. January 3, 2013. http://cciio.cms.gov/resources/files/ar-blueprint-exchange-letter-01-03-2013.pdf

Also of interest

Provided by the Henry J. Kaiser Family Foundation