Higher Rates of Preventive Health Care With Commercial Insurance Compared With Medicaid: Findings From the Arkansas Health Care Independence "Private Option" Program.

BACKGROUND: A requirement of the Arkansas Medicaid Section 1115 demonstration waiver was to evaluate the level of care received for Medicaid expansion eligible beneficiaries enrolled in commercial Qualified Health Plans (QHPs) in the Health Care Independence "Private Option" Program. This allowed for a direct comparison of Medicaid and commercial system performance serving similar newly covered adults. RESEARCH DESIGN: In 2014, assignment to either Medicaid or a QHP was made based upon a psychometrically derived continuous composite score to exceptional health care needs assessment screener using a sharp a priori threshold cutpoint. Using a regression discontinuity design we compared preventive care (flu vaccination and screening rates) services in the 2 programs over 3 years. RESULTS: Compared with Medicaid enrollees, a higher percentage of QHP enrollees consistently received eligible preventive care screenings with 15.3, and 6.9% more receiving at least 1 or all eligible screenings, respectively. For individual preventive care outcomes and compared with Medicaid enrollees over the 3 years under study, a higher percentage of eligible QHP enrollees received a flu shot, cholesterol screenings, glycated hemoglobin assessment, and cervical and breast cancer periodic assessments. No differences were found for colorectal periodic assessments. CONCLUSIONS: These findings suggest that at least for preventive services, the Medicaid federal equal access requirement is not being met for those within Medicaid fee-for-service coverage. This persisted across all 3 years of the program. Differential payment rates for services between Medicaid and QHPs are likely a major contributing factor.

Arkansas's novel approach to expanding health care coverage.

The state of Arkansas is implementing a novel approach to expanding health care coverage for individuals newly eligible for Medicaid under the Patient Protection and Affordable Care Act (ACA). Through a section 1115 demonstration waiver, the state will use federal funding via a premium assistance model to secure private health insurance offered through the newly formed health insurance marketplace to those individuals aged nineteen to sixty-four who have incomes at or below 138 percent of the federal poverty level. As of April 2014, the Health Care Independence Program (HCIP), as it is formally known, had over 155,000 individuals who had been determined eligible. The HCIP premium assistance approach is commonly referred to as the "private option" and was designed to achieve comparable access, network availability, quality of care, and opportunities for improved outcomes for HCIP enrollees (i.e., those who would be eligible for traditional, fee-for-service Medicaid through ACA expansion) when compared with their privately insured counterparts. This article provides the background, political discourse, policy development, evaluation strategy, and progress report for this innovative new program.