Gov. Hutchinson announces expansion of rural health services through Medicaid-backed health coverage
November 21-27, 2022
By The Daily Record
The U.S. Centers for Medicare (CMS) and Medicaid Services has granted Arkansas’ request to amend its expanded Medicaid health coverage program to include an innovative service to assist at-risk youth in rural areas, Gov. Asa Hutchinson announced on Nov. 1.
Formerly Arkansas Works, the Arkansas Health and Opportunity for Me (ARHOME) replaced the prior version of the expanded Medicaid health coverage program. ARHOME is Arkansas’ Medicaid expansion program created by the federal Affordable Care Act (ACA). It serves adults between the ages of 19 and 64 with income below 138% of the federal poverty level.
The program operates as a demonstration project approved under the authority of Section 1115 of the Social Security Act, which allows the state to use Medicaid funding to purchase coverage through private and qualified health plans from Arkansas Blue Cross Blue Shield, Arkansas Health & Wellness (Ambetter), and Qualchoice. The federal government pays 90% of the program’s cost, and the state pays the remaining 10%.
During the 2021 legislative session, state lawmakers approved Act 530 that changed the program to ARHOME, effective January 1, 2022. The federal Centers for Medicaid and Medicaid Services (CMS) approved the new five-year waiver on Dec. 21, 2021. According to Arkansas Department of Human Services officials, eligibility and enrollment for ARHOME has increased steadily since 2020 primarily due to the public health emergency caused by the COVID-19 pandemic.
CMS prohibits states from disenrolling clients from Medicaid programs for any reason, except when the client passes away, becomes incarcerated, moves out of state, requests to be disenrolled, or shifts to a different Medicaid program. That means clients who might have been disenrolled due to aging out of the program or because their income increased beyond the program limits.
The Life360 HOMEs amendment approved by CMS will address complex challenges facing many of Arkansas’ most vulnerable residents, including individuals with high-risk pregnancies, individuals in rural areas with serious mental illness (SMI) and substance use disorder (SUD) diagnoses, and young adults identified as most at risk for long term poverty and poor health outcomes. Life360 HOMEs, or Life360s, will aim to reduce maternal and infant mortality rates around the state, fill gaps in the continuum of care for individuals with SMI and SUD diagnoses, especially in rural areas, and increase active participation among beneficiaries in improving their health and addressing health-related social needs.
“These Life360 HOMEs are a critical component of the ARHOME program, and the additional services and supports that they will make available to Arkansans across this state have the potential to make a profound impact on the health of our citizens,” said Gov. Hutchinson. “Thank you to our federal partners and the teams at the Arkansas Department of Human Services for making this program a reality. I am eager to see the positive outcomes it will bring when it is fully implemented.”
Life360s will ensure clients in target populations are connected to medical services and nonmedical support in their communities to address their social determinants of health (SDOH) through intensive care coordination. Life360s are designed to supplement, not supplant, existing supports and services. Life360s also provide support for hospitals, especially those in rural areas.
There are three types of Life360s that will target populations to receive intensive care coordination services and support specifically designed to meet those populations’ unique needs:
Maternal Life360s will support women who have high-risk pregnancies. Intensive care coordination will be provided through home-visiting programs pre- and postnatal. Services will be provided during pregnancy and up to 24 months after the baby is born. Hospitals with obstetric units can be Maternal Life360s.
Rural Life360s will support individuals with mental illness or substance use disorder (SUD) who live in rural areas of the state by providing intensive care coordination through coaches employed by rural hospitals. They also directly provide community screens for health-related social needs for enrolled clients and will receive funding to operate an Acute Crisis Unit.
Success Life360s will support young adults most at risk of long-term poverty and associated poor health outcomes due to involvement with the foster care system, prior incarceration, or involvement with the juvenile justice system, and young adult veterans who are at high risk of homelessness. The Success Life360s will provide intensive care coordination directly or contract with community organizations to do so.
“Each of the three types of Life360s provides a connection to services that will make Arkansans healthier,” said DHS Secretary Mark White. “With today’s announcement that this innovative component of the ARHOME program has received federal approval, we are ready to deliver new supports that will lead to better health outcomes and stronger communities. These Life360s will mean intensive care coordination is available for a variety of Arkansans, including pregnant women and new moms, rural residents facing mental illness or substance use disorder, and young veterans, among many others. I’m grateful for the teams that have worked to make this announcement possible, and I’m truly excited for the potential of this transformative program.”
Different types of Arkansas Medicaid-enrolled hospitals can serve as Life360 providers. For the Maternal Life360 service, providers must be a birthing hospital that will provide or contract with an evidence-based home-visiting partner to provide home-visiting services to women with high-risk pregnancies for up to two years after a baby’s birth. Clients are eligible if they are enrolled in ARHOME or another Medicaid program, have a high-risk pregnancy diagnosis and are pregnant at the time of enrollment, live in the Life360 service area, and are not already receiving home-visiting services. Clients can be referred for diagnosis and Life360 services by OB/GYNs, QHPs, or community networks like homeless shelters and churches.
A Rural Life360 provider must be a general or critical access hospital with 50 or fewer beds located in a rural area of the state. These Life360s will directly provide community screens for health-related social needs and intensive care coordination for enrolled clients. Each approved Rural Life360 will also receive funding to operate an Acute Crisis Unit that’s available 24/7. Clients are eligible for care coordination services if they are enrolled in ARHOME, have a diagnosis of SMI or SUD, and live in the Life360 service area. Clients who are enrolled in a Provider-Led Arkansas Shared Savings Entity (PASSE) will continue to receive care coordination services through their PASSE, rather than a Life360 HOME.
Success Life360 providers must be an acute care hospital in Arkansas. Each provider will contract with community organizations with experience working with young adults most at risk of long-term poverty to build life skills. Clients are eligible if they are enrolled in ARHOME, live in the Life360 service area, and meet one of the four eligibility categories. They include veterans ages 19-30, those formerly in foster care ages 19-27, and those incarcerated or a Department of Youth Services client between the ages of 19-24.
Clients who are enrolled in a PASSE will continue to receive care coordination services through their PASSE, rather than a Life360 HOME. DHS is ready to accept letters of intent from potential Life360 HOMEs. For more information on the ARHOME Life360s, visit ar.gov/life360. A public comment period ended on Nov. 7.
Gov. Asa Hutchinson (second on left) announces plans at a State Capitol press conference on Nov. 1 to expand Arkansas Health and Opportunity for Me (ARHOME), the state's Medicaid health coverage. The Life360 HOMEs amendment approved by CMS will address complex challenges facing many of Arkansas’ most vulnerable residents.