CMS Allows Parents to Choose Between ARKids A and B, Despite Clinton Directive

The Arkansas Democrat-Gazette today reported that the Centers for Medicare and Medicaid Services will not enforce a Clinton administration directive requiring the state to enroll Medicaid-eligible children in ARKids A. However, a CMS spokesperson said that while the Clinton policy is still effective, the agency is "satisfied" with the program and will continue to allow parents to make enrollment decisions (Darryl Drevna, Kaiser Daily Health Policy Report, 9/20). According to the Democrat-Gazette, a senior CMS official at a conference in Little Rock, Ark., said the Bush administration would not enforce the policy. Speaking at a "Medicaid Horizons" conference, Dennis Smith, the director of CMS' Center for Medicaid and State Operations, indicated the Bush administration "approves" of how Arkansas is managing the program (Rowett, Arkansas Democrat-Gazette, 9/20). In July 2000, the Clinton administration ordered the state to enroll all Medicaid-eligible children in ARKids A, the state's traditional Medicaid program, instead of allowing parents to select to enroll their children in ARKids B, a Medicaid waiver program intended to cover children with higher incomes. The waiver program requires a "small" copayment and offers fewer services than the traditional Medicaid program. Saying that free coverage under the ARKids A program carries a "stigma," Gov. Mike Huckabee (R) wanted to allow parents of Medicaid-eligible children to choose between the two programs (Kaiser Daily Health Policy Report, 8/7). Huckabee and state Medicaid Director Ray Hanley "resisted" the Clinton directive, and the Democrat-Gazette reports the "impasse" has been solved now that the Bush administration has indicated it will not enforce the Clinton administration order.

Continuing the Program
The state had filed a waiver request in February that would have allowed parents to choose between the two programs, but Smith said after his speech that although the waiver has not been approved, the administration will allow the state to run the program without interference. Hanley said that Smith told him the enrollment debate was a "dead issue," adding, "They told us that so long as we give parents a free, informed choice that they're happy with the way we're doing this" (Arkansas Democrat-Gazette, 9/20). However, a CMS spokesperson today said Smith did not "specifically" say the directive would not be enforced, but instead that CMS would allow the program "to continue in the effective manner it has been running" (Darryl Drevna, Kaiser Daily Health Policy Report, 9/20). During his speech, Smith said, "We are going to respect the roles and responsibilities of the states, because they've built their programs and they know what is going to work best for them" (Arkansas Democrat-Gazette, 9/20).