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Saturday, December 2, 2017

#Arkansas

#Arkansas


Bielema contract buyout put at $11.8 million; total Hog exposure more than $19 million

Posted: 02 Dec 2017 06:47 AM PST


ESPN, quoting sources,
reported last night that Bret Bielema will receive $11.8 million for the three years remaining on his football coaching contract at Arkansas.

The money would be paid in monthly installments. It would be reduced by future earnings.

Add this to the buyout for Jeff Long, the fired athletic director, and potential buyouts for Bielema's staff of assistants (still employed) and you're talking potential payouts of up to $19 million to settle contract guarantees. It would be money from the income stream of the Athletic Department and Razorback Foundation, fattened by TV and marketing revenue and private contributions, not tax dollars.

If ESPN proves right, I'll claim an I-told-you so. A while back, the Arkansas Democrat-Gazette consulted a lawyer who said Bielema would be due only $5.9 million, though his contract seemed to specify a $15.4 million buyout. I remarked then that I was confident Bielema's lawyers would dispute the low-ball estimate. I relied on a letter memorializing his most recent contract amendment.

The key part follows. You can see it guaranteed him $15.4 million (paid by the Razorback Foundation) if fired in the year ending Dec. 31, 2017 and then dropping to $11.7 million for a firing Jan. 1, 2018.

Bielema was fired a little more than a month short of the day the payoff dropped to $11.7 million. Looks like, if ESPN is correct, the lawyers have agreed to the Jan. 1 payoff figure plus $100,000 for the final month of 2017. The University has referred questions to the Razorback Foundation. It has declined to provide information.
The Democrat-Gazette wasn't well-served by its lawyer in estimating Bielema's payoff, but I think they got worthy advice for an assertion in an article today that they believe Razorback Foundation information about the coaching contract should be open under the Freedom of Information Act. The Foundation is inextricably tied in numerous ways to the public university, including in cooperation on premium seat sales and negotiating coaching contracts and joint responsibility for payment of those contracts.

I've been told lawsuits in other states have succeeded in piercing the veil of similar nonprofit support groups. A leading legal authority on the FOI in Arkansas once encouraged me to sue over the issue, so sure was he that a case could be made. I couldn't afford it, having lost one expensive battle with a phalanx of UA lawyers in attempting to find out the terms of sale on the Waltons' purchase of the Fayetteville campus' education department.

Over the years, the Democrat-Gazette has done some important and expensive work in defending and expanding the FOI. Might it be ready to go to court over the Foundation's refusal to open its books? Times are tough in the publishing business and the D-G isn't as profitable as it once was. But publisher Walter Hussman has  made profit a secondary motive in his newspaper business in several worthwhile ways, including page-count and staffing. I hope this proves to be another of those times.

And a PS on the business of coaches' pay and guaranteed payouts. Hanging in the wind after Bielema's firing, as I've noted before, are his assistant coaches. Until a new coach is hired, their future employment is uncertain as I noted earlier. But here's a university summary of their current pay and what their buyouts would provide if fired Dec. 1. They remain employed.


It's worth noting that the contract with Bielema was one sore point among UA Trustees that led to their message to Chancellor Joseph Steinmetz to fire Athletic Director Jeff Long. Long has a $4.6 million buyout, also subject to mitigation by future employment. When all's done, if the assistant coaching staff goes, too, the Long era will leave a  potential $19 million hickey on the treasury of the Athletic Department and the Razorback Foundation. That figure is likely to be reduced by future earnings of all those fired.

Boozman quotes GOP spin machine; facts debunk him

Posted: 02 Dec 2017 06:04 AM PST

Dr. No Boozman rushed to Twitter this morning to proclaim the tax cut for the wealthy a gift to all Arkansans as he regurgitated party talking points. They are, at best, wishful thinking and, at worst, simply dishonest. Many Arkansans will keep less of their money and be bankrupted by health costs.

Take, for example, the former director of Congress' non-partisan Joint Tax Committee, which studies these things:

"It's not aimed at growth. It's not aimed at the middle class. It is at every turn carefully engineered to deliver a kiss to the donor class" 
More here from NY Times.

Class war over: Rich win. Senate passes a Christmas tree tax-cut bill

Posted: 02 Dec 2017 05:54 AM PST


The U.S. Senate early this morning voted 51-49 for a tax bill that will give huge tax cuts to corporations and the wealthy, increase the national deficit and bestow dozens of favors to special interests crammed into a bill passed without scant notice and without public review.

The 479-page bill came with numbers of favors for reluctant Republicans, some hand-written into the margins of the proposal shortly before the vote.

The bill still must go to conference for reconciliation with a House bill. It will be interesting to see if one particularly odious amendment, unexpectedly defeated by defection of four Republicans, will be put back in. This was a special exemption from a new tax on college endowments for the right-wing Hillsdale College, a major beneficiary of billionaire Education Secretary Betsy DeVoss.

The Washington Post notes that, as the bill evolved, it became more weighted in favor of the wealthy. It will actually increase taxes for many lower-income workers and by full implementation punish many in the middle class while awarding billions in tax breaks to the wealthy.

Republicans rejected numerous non-partisan findings that the bill will not produce the economic boon that they predict will override the deficit-increasing impact of the tax cuts.

The bill also damages the Affordable Care Act and inevitably — though Republican tried to dispute it — mean reductions in Medicare and Medicaid spending. Some 13 million people are expected to lose health insurance coverage as a result of the bill.

Most media are depicting this in terms of victory for Donald Trump and the Republican Congress. It is more accurately depicted as a battering loss for working class Americans, the very people who supposedly powered Trump's victory.

Need I mention that Arkansas's senators cheered the outcome and voted for all the terrible amendments? Arkansas's House Republicans stand ready to do the same.

Some forces of resistance were up early with responses.

Arkansas Advocates for Children and Families' Rich Huddleston wrote:

Both the Senate and House tax bills are costly new giveaways to the very wealthy and major corporations at the expense of working families, including tens of millions of low-income and middle-class Americans who actually would face a tax increase. In Arkansas, approximately half of the benefits of this tax cut will go to the top 5 percent of earners. By voting for this bill, Arkansas Senators Tom Cotton and John Boozman voted against the best interests of our children and hardworking families.

Make no mistake, these tax cuts will begin a domino effect that will debilitate programs our kids and families depend on for years to come.
Paul Spencer, a Democratic candidate for 2nd District Congresss hoping to unseat Plutocrat French Hill of Little Rock, said:

While most Americans were sleeping, the Republican-controlled Senate showed the American people just how far they are willing to go to obey their wealthy donors. At the expense of the people they are elected to represent, these Republican Senators have paved the way for a cascade of tax cuts for corporations and the wealthiest members of our society. With the passage of the "Tax Cuts and Jobs Act," the Republicans have utterly disregarded working and middle-class Americans, and have made clear their commitment to rigging the economy in the favor of a privileged few.
Many believe this vote will have election consequences in 2018. You'd think so. But we have evidence in the White House to discourage faith in facts and reason.

I can remember when Republicans said deficits matter. I can remember when they said legislation deserved ample consideration before votes. What we have here is the metaphorical equivalent of Donald Trump's pussy grabbing. When you're rich, you can grab whatever you want without fear of ill consequences.

Also criticism from Arkansas Communit Organizations — "The Senate tax plan that passed by a narrow margin last night will hurt working families in our state while giving millionaires like French Hill massive tax breaks" — and from 2nd District Democratic candidate Gwen Combs. She said: "The Senate's egregious pre-dawn vote for tax "reform" - which will hurt the vast majority of Arkansans - is merely the latest example of how true statesmen have been replaced by power-hungry shysters who serve only one master: Money."

Cultivation license award date set: Feb. 27

Posted: 01 Dec 2017 03:26 PM PST


The Medical Marijuana Commission will get "depersonalized" applications for cultivator licenses on Dec. 15, Department of Finance and Authority lawyer Joel DiPippa told the commission this afternoon at a jam-packed meeting, and, after some debate, the commission settled on a deadline of 4:30 p.m. Feb. 20 to turn in the scored applications. Staff at the Alcohol Beverage Control hired for the commission will collate results and provide the names of the top five scorers, those who will be eligible for the five licenses, at a meeting Feb. 27.  Should there be a tie for fourth place, the commissioners will be asked to review and rescore the tied applications, independently.

There are 95 applicants for cultivation licenses. DiPippa suggested the commission score the applications by Feb. 1, but the board said the holidays would make that deadline too difficult.

After staff finishes depersonalizing cultivator applications — removing applicant names — they'll begin redacting applications for the public, removing Social Security numbers, addresses and bank information, DiPippa said. However, he told the board that the public's copies of the applications would differ from the commission's, in that they would include names. Commissioner Dr. Carlos Roman objected, saying public release of names to the media — DiPippa told the board that 80 individuals have made FOIA requests for the information — would compromise the anonymity of the applicants and possibly confer an advantage on some of the competitors.

DiPippa responded that he's looking into case law on the subject. After the meeting, however, he cited to media representatives a portion of the FOIA law that says the public may be denied information that may give advantages to competitors. So it appears the public will not know who has applied for a cultivator license until Feb. 27, which contradicts what the Times published this week in its Cannabiz column.

Also on Feb. 27, the board will discuss proposed regulations for medical marijuana transportation.

DiPippa said the staff will be working on depersonalizing the dispensary applications, of which there are 227, while the commissioners review the cultivator applications.

One faith-based group recruits almost half of foster homes in Arkansas

Posted: 01 Dec 2017 03:22 PM PST

The CALL operates in 44 counties with plans for expansion. This story was produced by The Chronicle of Social Change.

When Ashley and John Herring of Heber Springs decided to become foster parents in 2009, they were told there were just four foster homes in Cleburne County. Children taken into state custody in this rural county in the Ozark foothills were often sent to homes or short-term placements in other communities, sometimes hours away.
For kids, being abruptly separated from school and other community supports only compounded the inherent trauma of family removal. For overburdened staff at the local office of the state Division of Children and Family Services, out-of-county placements entailed lost time and bureaucratic headaches.

Yet DCFS workers had little choice: There simply weren't enough placement options in Cleburne County (pop. 25,970) to keep up with the number of children coming into care.

Today, the county has 23 open foster homes, a five-fold increase since 2009.

"On average, in our county right now, there are about 33 kids in care," Ashley Herring said. "I have three right now, and some other families will have three, so we meet our need. We don't get ahead, [but] we haven't been in a situation in a while where we've just been terribly behind, and have to send, send, send out of county … . We would get very upset if a kid has to leave our county."

The vast majority of the county's new foster homes have been recruited into Arkansas's network not by a statewide campaign, but by The CALL, a Christian nonprofit that takes no state funding.

The CALL moved into Cleburne County in 2009, and has expanded its operation across the state since. Herring, who is a nurse, and her husband, a family practice doctor, have opened their home to 42 foster children over the past six years. In addition to the couple's five biological children, they have adopted one former foster child and are in the process of adopting two more. Herring now serves as The CALL's volunteer county coordinator.

The organization recruits potential foster parents, trains them, guides them through the state's certification process and provides ongoing assistance once the kids begin arriving. It has become the source of 40 percent of all foster homes in Arkansas, according to the DCFS, and "CALL families" have also adopted hundreds of children in the DCFS system.

All of this is done without any public money — state, federal or local. The CALL's $1.7 million budget comes from individual donations, churches, businesses, foundations and other private sources.

That also gives The CALL greater operational freedom than most child welfare providers. It means the faith-based organization is allowed to limit its recruitment and training only to those Christian households that meet its criteria. The CALL does not work with cohabiting couples, same-sex couples or couples who follow other faiths or who are nonreligious, instead referring such families to the DCFS directly.

"We really don't have any families in our county who are not CALL families, because even if they went through the state [training process] for some other reason, they end up just being a part of us and supporting and being supported by us — as long as, you know, they agree with the Apostle's Creed," Herring said.

National advocates have expressed concern that LGBT youth may face bias and discrimination within state foster care systems. Ellen Kahn, the director of the Human Rights Campaign Foundation's Children, Youth & Families Program, indicated by email that she was not familiar with The CALL specifically.

However, she wrote, "based on what is publicly known about The CALL, we would certainly have concerns about whether their families are safe placements for LGBTQ youth."

Making The CALL

The CALL was founded in 2007 by a group of church leaders and child advocates in Pulaski County. It now operates in 44 of Arkansas's 75 counties, with an additional 10 county outposts planned for 2018.

The DCFS needs the help: It has seen a record surge in numbers of fosters in the past two years, with 5,079 children in care as of early November. That's down slightly from a high of 5,200 last year, but still represents a 38 percent increase since 2012.

In a 2016 report, the DCFS itself bluntly stated that "the system is in crisis," an assessment echoed by Governor Hutchinson, who has pushed for more aggressive foster parent recruitment.

Hornby Zeller Associates, an outside contractor hired by the state to assess its foster care surge, found in 2016 that the state might be removing more kids than necessary. "The increase in foster care is due largely to two factors: the DCFS removing more children [from their homes] immediately upon investigation and the courts ordering removals against the recommendations of the agency," the consultant firm stated in its report.

Whatever the cause of the increase, the DCFS has come to consider The CALL an indispensable partner. In 2008, DCFS Deputy Director Beki Dunagan was working as a supervisor in Lonoke County, the second site The CALL targeted after its founding.

"Being in the field, in the weeds, I know what it is like," Dunagan said. "You remove children, and sometimes you might be in that office for seven hours trying to find a placement. Then you might end up with that child in an emergency shelter or a placement just for the night, and you start all over the next day."

After The CALL took off, she said, "it was like day and night. … Within an hour, we'd have children placed." When Lonoke County DCFS told the upstart nonprofit that it needed help providing snacks to kids visiting their parents after school at the DCFS office, The CALL mustered resources to do just that. "I can't even articulate to you the support I felt in Lonoke," Dunagan said.

Lauri Currier began working with the original Pulaski County chapter in 2008. In 2011, the growing number of county affiliates were organized into a statewide, 501(c)(3) nonprofit at the behest of the DCFS, and Currier was hired as its executive director.

The DCFS wanted The CALL to include "a central hub to create best practices, to do training … so there was consistency in how we were operating at the local level," she said.

Currier, who has been a teacher, a marketing director and a small business owner, said she was drawn to The CALL after "a self-discovery Bible study" led her to conclude her life's purpose was to "positively affect the lives of the fatherless." Currier's own family history played a role: When she was an 18-year-old college freshman, her father revealed to her that he was adopted.

"My dad was brought into foster care in 1939, with four siblings," she said. "He had a younger sister and three older brothers, and they got split up and never got back together until much later in their lives, when they were in their 40s and 50s. There was such a stigma about adoption that my grandmother's wish — my father's adoptive mother — was that he not tell anyone until after she passed. … That is why I do the work that I do."

Between church and state

Currier said the key to The CALL's recruitment success is building relationships within each church it works with. The group partners with about 700 of the estimated 5,000 churches in the state, Currier said.

"We identify generally someone in that church who is a layperson — somebody that's passionate about kids in foster care," she said. "Maybe it's a foster parent or adoptive parent or someone who was a foster child when they were young. We train that person to kind of be our representative in the church."

The representative will then connect any member of the congregation who expresses an interest in foster care to The CALL.

Recruitment is only the first step. The foster care certification process "can be very daunting in that there a lot of requirements, a lot of hoops you're having to jump through," Currier said. "We're walking alongside [the family] and helping them stay on track." At the same time, "we want to make sure that we're appropriately vetting families, and we do that according to what DCFS' standards are."

Potential foster parents in Arkansas have often complained of lost paperwork and endless delays, so The CALL's assistance can make a major difference. In 2015, a review of the DCFS commissioned by the governor and conducted by consultant Paul Vincent of the Child Welfare Policy and Practice Group found the overstretched agency was having trouble moving new foster parents through the certification process.

"Difficulty in securing staff and other barriers ... resulted in a large backlog of prospective foster parent inquires, applications and background clearances that the system couldn't respond to in a timely manner," Vincent wrote at the time. (The DCFS said later that it resolved the backlog issues.)

Foster parent Ashley Herring said local DCFS employees were dedicated and diligent — and also "the most overworked people I've ever seen." That's why Herring maintains her own tracking system to keep up with potential foster families as they move through the process.

Herring said her local DCFS resource worker told her she manages 83 cases spread over four counties. (Resource workers are responsible for opening and closing foster homes; they are distinct from caseworkers, who manage individual child welfare cases.)

"If I only counted on her to walk my families through, you can imagine which files would be on the bottom," Herring said. "I go meet with her once a month. We sit down together and I say 'This family, right there — where are they? Have they had their fingerprints? Have they done this, or this?'"

Perhaps the most visible advantage of being a "CALL family" is a compressed training schedule. Arkansas statute requires foster families to undergo a specific 30-hour training model called Foster/Adopt PRIDE, which the DCFS provides through a nonprofit contractor. PRIDE classes take place each Saturday over a two-month period in just five sites throughout the state, meaning families in remote areas may have to drive hours to attend.

In contrast, The CALL's training is delivered locally and compresses the PRIDE curriculum into two weekends. "We knew there are awesome Christian families that would be available to do something like this, but they're busy families," Currier said. So, The CALL obtained permission from the DCFS to create an adapted version of PRIDE.

"We'd have a weekend of training which would start on Saturday morning at 9 o'clock and go until 7 in the evening," Currier said. "Then, on Sunday, they'd show up at 1 and stay till 7. And then we skip a weekend, and then they'd come back for that marathon again."

In 2010, the independent consultant Hornby Zeller Associates performed a study at the request of the DCFS that compared the experience of CALL-recruited families to DCFS-recruited families. Hornby Zeller found a strong preference for The CALL's expedited training schedule and also found that CALL families "averaged roughly 37 days between their home study date and approval date. Meanwhile, the DCFS-recruited families waited nearly twice as long (73 days) between their home study date and approval date."

Evidence suggests The CALL has reached families that the DCFS could not recruit on its own. A 2013 paper authored by Michael Howell-Moroney, a researcher at the University of Memphis, found that 36 percent of CALL families said they probably would not have become foster or adoptive parents if it had not been for the nonprofit. Hornby Zeller similarly found that "several CALL-recruited parents stated that they would not have fostered if not for the Christian environment promoted by The CALL."

Questions of equity

Arkansas is an overwhelmingly Christian state, with 79 percent of adults identifying as such in a Pew Research Center poll. The number is likely higher in many rural counties.

For non-Christians and unmarried potential foster parents, The CALL is simply not an option. Any prospective family is asked to provide a letter of reference from their congregation, and must sign a statement of faith, which Currier described as an adaptation of the Apostle's Creed.

"There's no unkindness involved in that decision. It's just who we are as an organization," Currier said. "We will always kindly refer those families [to the DCFS] ... for them to be able to become foster and adoptive families."

The desire by some faith-based groups to limit their recruitment to Christian couples has become a hot-button political issue. Several states, including Texas, Virginia, Mississippi and Michigan, have passed laws that exempt faith-based providers from working with same-sex foster and adoptive parents.

But those laws relate to organizations that receive funding from state child welfare agencies. The CALL does not receive a single government dollar for supplying nearly half of Arkansas's foster homes.

"We would hope that the Arkansas [Division] of Children and Family Services is doing its due diligence to insure a safe placement for all children and youth in foster care," said Ellen Kahn, of the Human Rights Campaign Foundation. "Not all families will be suitable for supporting an LGBTQ child."

Asked whether The CALL's limited focus on certain types of families creates challenges for the DCFS, Dunagan noted that the onus for recruitment ultimately lies with the agency.

"It takes a village … and The CALL is just one part, although it's a major part, of our village," she said. "I will tell you that I think in years past we did not do a very good job of engaging other training partners or having specific targeted recruitment."

Dunagan said the DCFS has ramped up its own foster care outreach in communities across the state, thanks in part to a grant from the U.S. Department of Health and Human Services.

"I do think we do need to do some additional work with LGBT," Dunagan acknowledged. The DCFS is making efforts to recruit more same-sex couples interested in becoming foster parents, she said.

Amy Webb, a spokesperson for the Department of Human Services, the agency that oversees DCFS, wrote in an email that the agency does not necessarily avoid placing youth who identify as LGBT with CALL-recruited families. It does take into account the preferences of the child and the foster parents, she said, so as to ensure stable placements.

"We may have youth who prefer not to be in a home with a same-sex couple or who would prefer a same-sex couple home because that is what they are used to," Webb said. "Or we may have great foster parents who honestly say they don't know how best to support LGBT youth and asked that they not be placed in their home."

Currier said the state-mandated training curriculum delivered by The CALL "addresses the topic of appropriate interactions with LGBT children and youth in foster care."

Asked whether The CALL avoids proselytizing to LGBT foster children, Currier replied that "DCFS provides policies and guidelines regarding respecting the beliefs of children and youth in foster care. The families recruited by The CALL follow these policies and guidelines. These families simply live out their Christian faith on a daily basis as an example of a way of living."

The Chronicle of Social Change is a national news outlet that covers issues affecting vulnerable children, youth and their families. Sign up for its newsletter or follow The Chronicle of Social Change on Facebook or Twitter.

Arkansas still waiting on federal approval for Medicaid changes

Posted: 01 Dec 2017 03:17 PM PST

Proposal to limit eligibility could face tough scrutiny from feds. Already at least a month behind schedule on implementing a series of proposed changes to the state's Medicaid expansion program, Arkansas Works, Governor Hutchinson still has received no word on the federal approval he needs to move forward.

Last week, Hutchinson met with federal officials to plead his case. "I have personally visited with numerous Administration officials making the case for Arkansas' innovative Medicaid waiver request that would continue the reform efforts to control costs and to put into place work and responsibility requirements," Hutchinson said in an email. "These meetings have been productive."

In June, the state submitted a request to the Trump administration for a series of alterations, including work requirements and a change in eligibility that would remove tens of thousands of Arkansans from the rolls. Hutchinson has consistently said that he is confident that the changes will be approved, but has expressed some anxiety in recent months about the timeline. The original target start date of Jan. 1 is no longer a possibility, state officials say. The Department of Human Services told the Arkansas Nonprofit News Network last month that in order to initiate the necessary alterations in program infrastructure, it would need 60 days to implement the changes once the state receives federal approval.

In early November, a spokesperson for the governor said that Hutchinson was optimistic about receiving an answer by Nov. 7. With no response more than three weeks later, Hutchinson said that he still believes his efforts are on course.

"The timeline for the response to the waiver may be delayed because of the resignation of former [federal Health and Human Services] Secretary Price and the fact that the new Secretary has not yet been confirmed by the Senate," Hutchinson wrote by email. "While the final waiver decision has not yet been made, I am confident that we are on the right track and that the reforms under Arkansas Works will continue."

At least some federal officials are reportedly leery of the state's request to limit Medicaid expansion eligibility. Asked specifically whether he had concerns that this provision might be in jeopardy, the governor did not respond directly, but wrote that in all of his meetings with federal officials, "the Administration has recognized the unique features of Arkansas Works and how the proposed reforms are consistent with providing the states with more flexibility and the ability to restrain the growth of the Medicaid budget — both federally and in the state."

More than 300,000 Arkansans are currently covered under the Medicaid expansion, which provides health insurance to adults who make less than 138 percent of the federal poverty level (that's around $16,500 for an individual or $34,000 for a family of four). The federal Affordable Care Act (ACA) provides most of the funding for states that have chosen to expand Medicaid. Arkansas opted to do so in 2014, during the Gov. Mike Beebe administration, via a unique approach then known as the private option, which used Medicaid funds to purchase private health care plans for eligible low-income Arkansans. Hutchinson kept this policy — which he re-branded Arkansas Works — in place, but received federal approval for a new waiver of Medicaid rules to implement a few changes last year, including imposing small premiums on certain beneficiaries.

The election of President Trump opened the possibility for additional changes that the Obama administration would not approve. In June, the state submitted a request for a series of amendments to the Arkansas Works waiver. The most dramatic alterations would reduce the number of Arkansans eligible for the program and impose work requirements on most beneficiaries who remain.

Enrollment would be limited to those who make less than 100 percent of the federal poverty level (that's around $12,000 for an individual or $24,500 for a family of four). According to the DHS, that means around 61,000 current beneficiaries — those who make between 100 and 138 percent of the FPL — would be removed from the program. They would then be eligible for either employer-sponsored health insurance or federally subsidized private coverage on the ACA marketplace.

Among remaining beneficiaries, those between the ages of 18-49 would be required to work 80 hours per month; if they were not working, they would have to participate in job training programs or certain approved volunteer activities. Beneficiaries would have to be in compliance for nine months out of the year or they would be removed from the program for the duration of the year. Beneficiaries 50 or older would not be subject to the work requirement; exemptions would be available for others who met certain criteria, such as caring for dependent children.

These two headline amendments — work requirements and limiting eligibility to 100 percent of the federal poverty level — were lines in the sand that the Obama administration was unwilling to approve. The Trump administration, however, has signaled that it would allow states greater leeway to use waivers to make conservative alterations to Medicaid expansion.

Most observers believe that approval for the state's request for work requirements is a sure thing, but it's less clear whether the Trump administration will go along with Hutchinson's proposed reduction in eligibility. Politico reported in October that Seema Verma, who directs the federal Centers for Medicare and Medicaid Services, wrote a draft memo that summarized options but did not make a recommendation on the issue of "partial expansion" — limiting Medicaid expansion coverage to 100 percent of the federal poverty level rather than 138 percent as prescribed by the ACA, as Arkansas now proposes to do. Politico, citing two unnamed sources, reported that the memo included objections from some White House staffers expressing "reservations about granting such expansions and letting states tap into Obamacare's generous federal funding boost."

One challenge for the Trump administration in analyzing Hutchinson's partial expansion proposal is the possibility of setting a precedent that other states may want to follow. Red states that have thus far declined to expand Medicaid may be motivated to do so if they too can acquire a waiver to limit eligibility to the poverty line. Meanwhile, current expansion states could also have an interest in piggybacking on the Arkansas proposal in order to save money for state budgets. States chip in for a small percentage of the costs of Medicaid expansion; if the 100-138 population moves out of Medicaid, states would no longer be on the hook for that contribution. That would save more than $60 million over four years for Arkansas, according to estimates from the DHS. Other states will likely come calling for the same deal if Hutchinson's proposal is approved. That includes some blue states, too: In September, Massachusetts asked for a similar waiver amendment for partial expansion.

The politics for the Trump administration are complex as it weighs the possibility of opening the door to partial expansion. On the one hand, partial expansion might be seen as a conservative win that reverses the Obama administration's guidance and reduces the eligibility for Medicaid expansion. However, granting partial expansion might lead to more states expanding Medicaid, which could be viewed as a win for Obamacare that President Trump is loathe to grant. Granting partial expansion would also lead to higher numbers of people in the ACA marketplaces, which could likewise be construed as news that helps the optics of the health care law that Trump remains eager to repeal.

It's not just political symbolism that might worry the Trump administration. The budgetary implications of transitions to partial expansion are complicated, but in general federal officials may have reason to fear that a large group of states making this switch will increase federal costs. With no state contribution, the cost of subsidizing coverage for people in the 100-38 population who moved to the ACA marketplace would fall entirely on the federal government (the beneficiaries themselves would also typically be on the hook for more costs if moved from Medicaid to the marketplace). The potential impact on the federal budget would be somewhat muted in Arkansas. Because of the state's unique "private option" approach — Medicaid covers this population by purchasing private plans on the ACA marketplace — the shift in Arkansas would involve who pays for the coverage, but the plans themselves would be the same. But in other piggyback states, such as Massachusetts, the coverage itself would be more expensive under partial expansion, because the 100-138 population would move from Medicaid plans to private plans. Those private plans typically cost significantly more, potentially leading to dramatic cost increases overall if the same levels of coverage are maintained. Meanwhile, if red states that have thus far resisted Medicaid expansion decide to move forward because of a new option for partial expansion, that would also increase federal costs.

Given the complications of setting a precedent for partial expansion, it is notable that Hutchinson emphasized that "the Administration has recognized the unique features of Arkansas Works." Those "unique features" could be part of one possible pitch to the Trump administration: The governor could make the case to narrowly tailor federal approval to partial expansion only in Arkansas, without setting up a domino effect for other states. Because the peculiarities of the private option create different policy and budgetary implications, perhaps the Trump administration could give the OK to Arkansas without opening the floodgates in other states.

This would likely be possible strictly as a legal matter, said Nicholas Bagley, a University of Michigan law professor who has written on partial expansion, but it would create major political headaches for the administration.

"It's true that Arkansas is unusual," Bagley said. "Maybe it's so unusual that CMS could approve a partial expansion for Arkansas and no other state. But if that's the approach CMS takes, the agency will have to fend off angry state policymakers and federal legislators who will argue that Arkansas has been given special treatment. The claim that Arkansas is different won't placate them. And CMS needs those policymakers and legislators to achieve lots of its goals. The agency will worry — rightly — about ticking them off."

As for whether another state might be ticked off enough to file a lawsuit, Bagley said, "A lawsuit probably wouldn't go anywhere: All the courts will ask is whether the agency had a reasonable basis for distinguishing Arkansas from another state. And since Arkansas is genuinely unusual, the agency should be able to meet that burden."

The political and budgetary stakes are high for Hutchinson as he awaits word on the partial expansion question. The projected savings are not baked into the state budget for this fiscal year, which runs through the end of June. But the budget picture moving forward will be substantially altered depending on whether or not the tens of millions in projected state savings from the eligibility change are forthcoming. In January, the governor will present his proposed budget for the next fiscal year to the legislature; it will only include savings from the change in Medicaid eligibility if federal approval has been received at that time.

The reduction in eligibility is also a key part of Hutchinson's argument for the continuation of Arkansas Works, which has faced frequent challenges from conservative opponents in the legislature. In the last two legislative fiscal sessions, the program narrowly survived uphill battles to secure the appropriation to continue the program. The political future of the state's Medicaid expansion program has teetered in doubt since the day it was passed; if the federal government turns down Hutchinson's request, the reauthorization fight is likely to heat up once again.

If the federal government does approve the state's request, advocates for beneficiaries warn that the state's working poor will end up paying the price. "Our greatest concern is that tens of thousands of Arkansans will become uninsured because they are no longer eligible for Arkansas Works, unable to afford other coverage, or simply fall through the cracks because of the constant policy changes," said Marquita Little, health policy director for Arkansas Advocates for Children and Families.

The governor's proposal is more popular among those who oppose the Medicaid expansion altogether. "Americans for Prosperity Arkansas has always opposed Medicaid expansion, but the waivers represent strong steps in the right direction," said Ryan Norris, state director for the advocacy group. "That said, we continue to believe the state should wind down the program entirely."

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.

The Cotton Dominoes Edition

Posted: 01 Dec 2017 03:09 PM PST


Tom Cotton headed to the CIA, Razorbackland in turmoil and more — covered on this week's podcast.

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Just saying ... Tom Cotton and Mike Flynn have a history

Posted: 01 Dec 2017 02:06 PM PST

Mike Flynn's guilty plea has opponents of the Trump administration tying Flynn to others, including Vice President Mike Pence.

In the Tweet above, Phillipe Reines, a political consultant who worked for Hillary Clinton, adds another interesting connection, Tom Cotton.

What did he know? And when? Mother Jones calls Cotton a "reliable mouthpiece" on Trump's line on Russia should he become CIA director.