House Public Health

Jan. 19, 2023 

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Rep L Johnson: We’ll call this meeting to order. Appreciate everybody coming in a little early today. We got a full agenda. We won’t get to everything on the agenda, but we’re going to get to some of this today. And to begin the meeting, we’re going to hear from DHS. I think they’re here this morning. I don’t know, is Mark White in the room? He is not in the room. Then what we’ll do is go on to hearing bills. That’s okay with me. We’ll circle back. Let’s see. I don’t see anyone in the room that was ready. Is Representative Scott in the room? All right, Representative McGrew, are you here? We will hear your bill if you’ll come to the table. Do what? That may be a discussion before we’re all sitting down. Let’s not embrace the paper yet. We’ll have a talk about that at the end of the meeting. Representative McGrew, you’re recognized.


HB 1015 Exempts Hot Springs Village from trust fund obligations

Rep McGrew: Thank you very much. Committee members, I’ve got House Bill 1015 today. What this bill does is a few years ago, there was a change that changed the communities and how they were accepted. What this does is add to the list to exempt them, such as the federal foundations, universities, and colleges, and entities for any community that’s 5,000 or more. And specifically, I represent Hot Springs Village. Hot Springs Village is a community of over 17,000 in my district. If it was a city, I think there’s 502 cities in Arkansas, it would be rated Number 26. Their facilities are manned and maintained and have met all requirements in the past. So this would put them at the same place that a municipality was on those requirements. And that’s what this bill does, and I’ll be available for any questions.


Rep L Johnson: Any questions from the committee? Representative Ladyman, you are recognized.


Rep Ladyman: Representative McGrew– thank you Mr. Chairman. It looks like what your bill does, it exempts those cities exceeding 5,000 population from NPDES permits. They don’t have to get those permits because they only discharged domestic waste. Is that basically what your bill does?


Rep McGrew: That’s my understanding, but let me ask you if I can get Mr. Grippe up here. He can assist me with any questions.


York (ADEQ): My understanding of the–


Rep L Johnson: Sorry. If you could identify yourself.


York (ADEQ): I’m sorry. My name is Alan York. I’m the Associate Director of the Office of Water Quality at Arkansas DEQ. My understanding of the bill the way it’s drafted is to exempt homeowners or property owners associations that are greater than 5,000 members from the non-municipal domestic wastewater trust fund contribution each year. Right now, Hot Springs Village operates two permitted NPDES facilities. NPDES stands for the National Pollution Discharge Elimination System. They are still required to be permitted. It wouldn’t change any of the requirements under federal rules. What it would do is basically exempt them from contributing to the trust fund each year for those two facilities. They contribute $5,000 per year per facility towards that trust fund.


Rep Ladyman: So it would make them more like municipalities as far as their operations go. Is that correct?


York (ADEQ): Correct. As far as the trust fund is concerned, it would exempt them from that contribution.


York (ADEQ): Thank you.


Rep L Johnson: Representative Gonzalez, you’re recognized.


Rep Gonzales: Thank you Mr. Chair. What is this trust fund for?


York (ADEQ): The trust fund is to step in when there is a failure of a non-municipal domestic wastewater system. In Arkansas, we have numerous systems, Hot Springs Village is the only one of this kind of size or scope that have their own discharge permits to operate wastewater systems for small communities, neighborhoods, etc. This would exempt them from that trust fund and that trust fund basically steps in if you have a failure or if one goes bankrupt or things like that.


Rep Gonzales: So we’re going to exempt them from the trust fund, but then they’re still going to benefit from the trust fund because they still qualify as one of those facilities?


York (ADEQ): It’s entirely possible, but not likely. We had some discussions with Hot Springs Village regarding the reserves that they keep on hand, and I’ll certainly be happy to ask them to speak to that. But they assured us that they had adequate reserves to cover both their wastewater and their drinking water systems, if any issues should arise.


Rep Gonzales: Okay, thank you.


Rep L Johnson: I think Representative Wardlaw, did you have a question?


Rep Wardlaw: Yes, sir.


Rep L Johnson: You’re recognized.


Rep Wardlaw: Representative Gonzalez touched on where I was going. But there’s no requirement in this bill, and I scanned through it really quick, there’s no requirement in this bill for that reserve fund to be at a certain level. And if we’re going to take them out of contributing to the trust fund, we probably should have some kind of reserve mark that would ensure that the state is not paying for that for somebody that’s not contributing to that trust fund. Representative McGrew, how do you plan on addressing this when the day comes? I mean, we’ve seen some of this happen with landfills. We’ve seen it happen with our tire districts. Where is the assurance that we’re not out paying for all these people 10, 15 years from now or 20 years from now, and they haven’t paid into this trust fund over those years when everybody else has?


Rep McGrew: And I understand that. Let me point out that Hot Springs Village is 50 years old. Hot Springs Village is the biggest gated community in the United States. Their financial impact on a recent study showed that they contribute $397 million annually to Arkansas, and because they are a gated community, they get nothing from the state. Nothing to support their infrastructure, their roads, their police department, their fire department or anything. So to me, their contribution weigh out most of that. And also, the fact that they have reserve to do that, that they are huge community, they’re the 26th largest in the state, and we’re just asking that they be treated like the others. So I understand the concerns there, but I think the contributions that they make, the promises that they make outweigh that.


Rep Wardlaw: Okay, we keep referring back to these reserves, and I’m not worried about their police and fire. That’s not what we’re talking about here. We’re talking about the sewer. There’s no requirement in this bill on what that reserve needs to be. I mean, we’re talking about they have these huge reserves and I’m fine with that. I think that’s great. But why not require that huge reserve be reserved for a disaster, if one was to take place, so that the trust fund is not liable for that if they’re not going to contribute.


Rep McGrew: So I guess I could pull back the bill and talk with them and amend it to put in there that they have a certain reserve. Is that what you’re asking for?


Rep Wardlaw: Yes, sir. I think that would make everybody feel a little more comfortable that they’re not going to hit the trust fund once they pull out of the trust fund.


Rep McGrew: Okay, I would be willing to pull this back and add that amendment.


Rep Wardlaw: Thank you.


Rep L Johnson: Are there any other questions from the committee? All right. Thank you, Representative McGrew. We look forward to seeing that amendment when you come back. Thank you.


Rep McGrew: Thank you.


Rep L Johnson: Representative Pilkington. Are you ready to present your bill? Do you have an amendment? Do you want to present your amendment first? Is that easier? What’s easier for you?


Rep Pilkington: Let’s do the amendment first.


Rep L Johnson: Yeah, this is to House Bill 1009?


Rep Pilkington: Yes.


Rep L Johnson: Okay. So if it’s okay with committee and again, there’s several bills we’re going to try to hear that members have approached, and we’re going to maybe be taking some of these out of the order of agenda without objection. Trying to just organize the bills in the way of how much time I think they’re going to take, anticipated by talking to members. If it’s okay, Representative Pilkington, after you present your amendment, but before you present your next bill, I may let Representative Scott come and present a bill.


Rep Pilkington: Sure.


Rep L Johnson: Okay.


Rep Pilkington: That’s not an issue at all.


Rep L Johnson: So the amendment should be passing out to you. This is amendment to House Bill 1009, and Representative Pilkington, you are recognized to present your amendment.

HB 1009 Amendment to Medicaid transportation bill (passed)

Rep Pilkington: Thank you. I’ll just wait until I get the actual language of the amendment. But real quick, I can tell you all kind of the background on this. As you know, two sessions ago, I ran a bill to create a pilot program for ride sharing for non-emergent transportation using Medicaid funds. There’s been other pilot programs like this in other states, District of Columbia as well. So one of the things that happened was basically time went by, COVID came and went, or faded, and there was still no pilot program. And so I filed this bill to say, well, if you want to do the pilot program, we’re just going to go and do the program fully. Come to find out, we did do the pilot program. It got shut down due to some issues and some incidents that needed to be resolved. DHS was working through that. And so in my meeting last week with them, they had asked me that I made some changes so that we could strike the language from the original bill, add this new bill to create an expansion study work group and so that the non-emergent transportation groups can work together with DHS to get this program back up and running. So that’s essentially what this bill is. I’m not running it today. I’m just amending it. That’ll give you all plenty of time to review it. But it’s a really simple, non-controversial bill. And I appreciate DHS’s help working with me on it so that we can find innovative solutions to an area that’s bugged us for a long time.


Rep L Johnson: Thank you, Representative Pilkington. Anyone have any questions about his amendment? Can I get a motion to approve the amendment? Second? Yep. All those in favor? Your amendment is adopted. Thank you, Representative Pilkington. Representative Scott, are you here? Are you prepared to present your bill?  Come to the table.


Rep L Johnson: You are recognized.


HB 1145 Lupus Day

Rep Scott: Thank you, Mr. Chairman. Colleagues, today I bring House Bill 1145, which would designate April 23rd as Lupus Day in Arkansas. If you don’t know, lupus is an autoimmune disease which attacks the healthy tissues of your body. What may seem as a harmless rash one day can lead to more serious health conditions such as heart attack, stroke, seizures, and organ failure. Lupus affects women, and currently over 90% of the patients are women, and typically tend to be of childbearing age. In fact, 80% of the people that are diagnosed with lupus are women. When the symptoms become serious, the disease can drastically affect the livelihood of those it faces. Currently, there’s no cure for lupus, but with early diagnosis, many of the severe effects of the disease can be mitigated. It is my hope that this bill will raise awareness in the state. This bill was brought to me by a group of women who are advocating for lupus in my district. I have a friend who’s no longer with us, and she fought lupus for much of our adult adult life. She left behind two kids. And I have a family member that’s fighting lupus right now. Lupus impacts all communities. And it’s just my hope that this bill would just kind of bring more awareness to this issue in this state. I’m also working with DHS to kind of see what we can do with some better data collection in regards to lupus. And that’s all I have.


Rep L Johnson: Does anyone have any questions for Representative Scott? A motion do pass. Second, all those in favor say aye? Congratulations, your bill has passed, Representative Scott.


Rep Scott: Thank you so much, committee.


HB 1082 Occupational Therapy compact

Rep L Johnson: You’re welcome. Representative Pilkington, are you preparing now to present your bill, House Bill 1082?


Rep Pilkington: Yes.


Rep L Johnson: You are recognized, Representative Pilkington.


Rep Pilkington: Thank you, Chairman Johnson. I would like to ask Mr. Simms from the Council of State Governments to come up here with me as well so I can present my bill.


Rep L Johnson: Yes, certainly.


Rep Pilkington: Thank you.


Rep L Johnson: If you can just introduce yourself for the committee.


Simms: Hi, Carl Simms, I’m Deputy Program Director with the Council of State Governments. Thank you.


Rep Pilkington: This thing’s flying all over the place. They’re passing out a one-sheeter real quick to kind of– I know this is a little longer bill, but just to know what’s going on. So as you know, and we’ve seen this through a lot of these committees, we’ve got compacts after compacts. This is another one for occupational therapy. 22 states have already enacted it with six more states on the way. As you know, we try as much as we can here in Arkansas to make it easier for people who come to the state to work, especially if they have a licensure. And so that’s basically what this is. We have no known opposition. No one has signed up here to speak against it, only to speak for it. I think this is a good step in the right direction to once again make it easier for people who come to Arkansas who have these kind of expertise to get to work. I mean, I hear this over and over again in every health committee and subcommittee, workforce, workforce, workforce. And so I think anything we can do to make it easier for an occupational therapist to come and work in Arkansas, we should see what we can do to make it work. So with that, I ask for a good vote. Mr. Simms, if there’s anything you’d like to add.


Simms: Yeah, I just wanted to underline a few points regarding the compact. One, that it does preserve state sovereignty by not altering the scope of practice for occupational therapists, occupational therapy assistants. It preserves the process for initial licensure. It also enhances public protection by requiring an FBI background check for those wishing to seek a compact privilege, that’s the authorization to practice in other member states. And then it also allows compact member states to have access to a data system that allows them to share information if there’s an adverse action that occurs in the compact member state so they’re aware of those different actions and able to take appropriate action based on their state laws. Anyone who’s practicing in a compact member state has to abide by the laws and regulations of that state. Thank you.


Rep L Johnson: Does anyone have any questions?


Rep Pilkington: I’ll make a motion do pass.


Rep L Johnson: Okay. A motion to pass. And a second. All those in favor say aye. Congratulations, your bill has passed. Let’s see. Representative Bentley, do you have a bill that you’re prepared to–


Rep Bentley: Yeah.


Rep L Johnson: Excellent. Sorry, again, apologies. I’m trying to see who’s in the room ready to run bills. This is House Bill 1155. This is one the Representative approached me about today. She says she’s prepared to run the bill and we’re prepared to hear it. Representative Bentley, you’re recognized to run your bill.


HB 1155 Local zoning laws for home childcare facilities

Rep Bentley: Thank you, Chairman. Thank you, colleagues. For the past four years, we have been looking at ways of how we can increase child care accessibility across the state. The biggest need that we have is for infant to 3 years old, so it’s a really big need. I see Representative Grimlich, Zach, up there saying yes, we do. It’s a huge need for us. So that’s a really big area where we need to get some more child care across the state. So we’ve looked at how can we encourage entrepreneurs to start a business, for those moms at home to start a business to have their own child care at home. And we’ve looked and looked at what can we do in the state to make a difference? It’s really the only thing we came across, and it was just listening to Representative Ferguson who had an incident in his own community where this is happening. So if we have an individual who has a child care at home, they have four or five kids that they’re staying with. Sometimes, unfortunately, folks will come and try to treat them as a commercial business and try to change their home into a commercial business. So with a fire regulation saying they have to have a door that goes outside from every room, or they have to change the vent hood in their home, excessive things that they’re really not making a whole lot of money having four or five children in their home. They’re trying to turn them into a commercial business and actually shutting them down and making those women and those Arkansans unable to open up their business in their home and have accessible child care. So it’s very simple bill to be able to say that we’re going to treat a residential home like a residence that it is, and we’re not going to require them to have a commercial stove. We’re not going to require them to fulfill fire regulations for a commercial business, because it’s a residence. It’s a home. And they will fully follow– and I know you guys have a copy of the bill in front of you, but they’re going to follow all the regulations they currently have. Child care folks will make sure that they follow every other regulation. We’re just saying they’re not a commercial business. They’re not a commercial. They shouldn’t have to follow commercial regulations for fire and those things. And we don’t need to be shutting these people down trying to open up necessary child care for Arkansas. And with that, I will take some questions to give you guys a chance to pull it up if you’d like.


Rep L Johnson: Yes, Representative Ladyman. And apologies to the committee, we tried to print bills that I anticipated us running, but you know, it’s a fluid situation. And we’re going to be efficient in this committee, and everybody hopefully has some kind of electronic device that can pull this up on. Representative Ladyman, you are recognized to ask a question.


Rep Ladyman: Thank you, Mr. Chairman. Representative Bentley, is there any limit in this bill on the size of these operations? I mean, you can have a large multi-level building where they’re keeping kids. Is there any limit?


Rep Bentley: Yeah, if you look, there’s a huge amount of regulations through our child care system, and I could have had Tonya Williams here to answer those questions, but yes, it’s 5. Representative Ladyman, it says a home is a residence. So it’s not going to have some– it’s not going to have somebody that’s going to have a duplex with a huge day care that this is going to cover. This is a residence, and it’s very much restricted. If you look on page 2, they’re going to comply with all the applicable zoning and land use regulations and all the things that child care folks, Tonya Williams, and those folks already have all those regulations in place.


Rep Ladyman: So it’s a limit of 5 children?


Rep Bentley: Yes.


Rep Ladyman: Okay, thank you.


Rep L Johnson: There are any other questions from the committee? Representative Gramlich, you’re recognized.


Rep Gramlich: Thank you, Mr. Chairman. Are they going to still have to have business licenses and stuff to operate this?


Rep Bentley: Yeah, and I’m sorry, again, you guys will have the bill in front of you, but yes, on page 2, they’re going to have to have all of those follow through. If you look in there, zoning, fire and safety, all those things, building codes, they’re going to fully follow. And I could just read it to you guys. At the bottom of page 1, actually, the Division of Child Care and Early Childhood Education shall require every child care facility seeking licensure under the sub chapter to comply with applicable zoning and land use development regulations of the municipality and county where the child facility is located. So they have to follow all the regulations currently. We’re just saying you can’t treat them like a commercial business when it’s a home that the childcare facility’s in.


Rep Gramlich: Okay, thank you.


Rep L Johnson: Any other questions for Representative Bentley? Okay, motion? Would you like to make a motion on your bill?


Rep Bentley: I make a motion do pass, thank you.


Rep L Johnson: Second. All those in favor say, aye. Congratulations. Your bill is passed.


Rep Bentley: Thank you, committee, I appreciate it.


Rep L Johnson: Do we have representatives from DHS here now? Excellent. Sorry. We may have moved the meeting time on y’all unexpectedly. That’s for not giving you a little better notice. Shuffling around. Your chair will be better in the future at accommodating those things. Appreciate y’all being here today to give some information to the committee. Committee, I’d like to say before we get started, I know all of us have a lot of questions, I’m sure, for DHS that run the spectrum of things you could ask, right? It’s a large entity that covers a lot of different areas. And I want to make sure that everyone understands the intent of this meeting’s introductory, to get to know how to navigate through DHS. I’d like to try to hold questions to the end of the presentation. And if you have questions, I’d like to try to ask that you limit those to specifics about how to logistically contact people. We’re going to have opportunities to dive into specific issues, I’m sure, at many, many times during this committee. So again, try to limit the questions to those specific logistic ideas and not dive into specific policy issues, if that’s okay. And with that, you’re recognized to introduce yourselves and present to the committee.


Putnam (DHS): Good morning, Christy Putnam, secretary, Department of Human Services, and with me today, I have–


Mann (DHS): Good morning, Janet Mann, deputy of Health and Medicaid Director.


White (DHS): And Mark White, chief of staff.


Putnam (DHS): And we also have Laurie MacDonald, who is Constituent Services historically, but she has stepped into the Legislative Affairs Coordinator role. So we’re very grateful to her for taking on additional duties.


Mann (DHS): And there’s additionally staff, Elizabeth Pittman, who’s the Director of Medical Services, and also Paula Stone, who is Interim Children’s Instructor for BH. Did I miss anyone? Okay.


DHS Presentation

Putnam (DHS): So what we wanted to do today, we do have a very– DHS is a very large agency as Chair Johnson mentioned. We know you will have lots of questions of us. We are comprised of, just very high-level, Department for Youth and Families and the Department of Health. And then we also have Shared Services within our agency, a separate shared services group. We will go into more of those areas, but today we wanted to focus primarily on giving you an overview of Medicaid. And so with that, I’d like Mark White to kick us off.



White (DHS): Thank you, Secretary Putnam. So talking through Medicaid, the first thing we want to put out there is something that always confuses folks if you don’t work in this day-to-day. I know it took me several months to get the distinctions straight in my mind when I started at DHS. But that is the distinction between Medicare and Medicaid. Of course, Medicare is a federal program. It is primarily for our citizens who are 65 years of age or older, as well as those who have been declared disabled by the Social Security Administration. It’s funded by Medicare taxes, charged on our payrolls, and it is operated most entirely by the federal government. We, as a state, do not have a role in administering the Medicare program. Medicaid, on the other hand, is for, of course, individuals with lower incomes, but also individuals with disabilities, and children, and other populations that have particular needs. Medicaid, as contrast to Medicare, is administered by the state in cooperation with the federal government. We operate under a set of federal rules, but we also do have some discretion in how we administer the program under those federal rules. And financially is a partnership, on average, the federal government pays about 76% of the cost of what we pay on Medicaid with the state picking up the remainder of that cost. Provides benefits through healthcare providers around the state. And a couple of things I’ll mention, there is some overlap between Medicaid and Medicare. One is that we do have beneficiaries who are on both programs. And so we coordinate with Medicare on what is paid for by Medicare, what’s paid for by Medicaid. But secondly, and this is one that’s particularly important that you want to keep in mind around provider payment rates, we do have limits on how much we can pay medical providers under Medicaid. And those limits are tied to what Medicare pays for similar services. And so that does give us some restrictions on our discretion in terms of when we set payment rates for providers.


Putnam (DHS): So each state has to submit a Medicaid state plan indicating how the state plans to run the program. We submit it to the federal centers for Medicare and Medicaid services or CMS, and we outline details in how we’re going to operate. If we want to make changes, there is some flexibility allowed to states. We have to submit a state plan amendment to CMS or a waiver request. And those are two very different processes. The state plan amendment is a formal plan to change how Medicaid services are operated in the state, does not have a cost or a budget requirement. It’s typically a 90-day process to submit a state plan amendment and work through that process with CMS. Although they can suspend the clock of that process requesting additional information. And that change is a permanent change to the Medicaid operations. In contrast, a waiver request is a formal request to waive certain requirements of the Medicaid program itself, the federal Medicaid program. It does require that request to be cost-effective or budget neutral. So there’s no increase or it’s more cost-effective to waive the certain requirement. And if the request is approved and the state does receive that official waiver, it’s a time-limited waiver. The states can request renewal, but the state does have to go back and seek approval each time it comes up for renewal.


White (DHS): And one point I want to put out there is, as part of administering the program, we do have extensive administrative rules, and those rules set out how providers bill us, what we’ll pay for, what rates we pay, and other details around the program. And so you, as a committee– we have to bring any change in those rules or any new rule, has to be reviewed by public health. And so that’s something that you’ll be seeing through us over the next two years is we’ll be regularly bringing to you changes in those rules as we make changes through those state plan amendments, or through those waiver amendments.


Mann (DHS): On the next page, we have an outline of just how many Arkansans we are serving in the state. Primarily, with Arkids A and B, it’s approximately 387,000; in ARhome, 348,000; all the way down the page to adoption and foster care, which is approximately 16,000 in the state. We have copies with us to hand out. We apologize since– yeah, I could say [laughter]–


Rep L Johnson: My apologies, committee, we’re going to work through this paper situation. It’s going to be– it’s going to be Papergate before it’s all said and done. Just pass them down, and around, and we’ll get those passed out. Thank you.


Mann (DHS): Sorry about that. Anyway, so currently there are approximately 1.1 million Arkansans on the Medicaid program. And when you receive page four, you will see the approximate breakdown of the beneficiaries. I’ll wait for her to finish handing that out. Page four. Okay, so as indicated earlier, on page four is our beneficiaries. And then on page five gives a brief summary of our providers in the state. So in FY 2022, we had approximately 101,000, almost 102,000 active providers enrolled in the Medicaid program. And then 49,000 of those actually billed us in that same year. And that is made up of 85 different provider types throughout the state.


Putnam (DHS): So general eligibility for Medicaid, clients must meet certain income limits based on a percentage of the federal poverty level, the FPL, and the number of people in their household. It’s a combination of factors. The FPL ranges from less than 20% and up to 250% of the FPL, depending on what category of Medicaid, the individual or family’s applying for. Limits are higher for children, pregnant women, and long-term services and supports clients, and they are lower for other adults. DHS redetermines a client’s eligibility every year. That’s been a little different during the public health emergency, and we’ll cover that in more detail later. Clients are required to report changes in their circumstances within 10 days. That could be a change to income or household composition. And then clients of long-term services, and supports, or LTSS have to meet asset limits in addition to the income limits. And they also have to meet an institutional level of care to qualify for that Medicaid.


White (DHS): And the next page, we’ve given you a chart, just giving you some idea of what those FPL percentages mean in terms of dollars. These dollar amounts are updated annually by the federal government. And so those do change from time to time. And I will say does create some confusion because there are so many different income thresholds and eligibility thresholds in Medicaid. And that’s just a legacy of over the last 50 years. Congress will see some situation, they’ll see a gap, they’ll pass a bill to fix that gap. But as a result, Medicaid eligibility is just this patchwork of more than a dozen different categories, all of which have different inconsistent requirements. And so that does create some confusion, but we work through that, and that’s why we’ve got eligibility staff. We train on this. We have an IT system that helps us with that processing so that when folks come in and apply, we can look at their situation, find which categories they’re eligible for, and then place them in the correct category. But as I said, you can see on there that chart that will show you based on how many individuals are in the household, what income would make them eligible for any particular category.


Mann (DHS): And I would just add that this chart is updated annually around April 1. The fed’s update it, and then we put it into our system effective April 1st.


Putnam (DHS): Right, and it’s an integrated eligibility system. It’s ARIES, so Arkansas Integrated Eligibility System that has all these categories in it in addition to our other public benefits programs.


Mann (DHS): Do you want to take the first one, the public health emergency?


Re-determining Medicaid eligibility

White (DHS): All right, so the public health emergency. We mentioned this earlier. In 2020, when the COVID-19 pandemic began, the federal government declared a public health emergency for COVID. And that public health emergency is still going on. It is extended about every three months by the US Department of Health and Human Services. One consequence of that is Congress early on in the pandemic– they issued a directive that said that state Medicaid programs would receive some enhanced funding during the pandemic. So an additional 6.2% that we receive on certain categories. But the consequence of that was we could not remove individuals from the Medicaid roles. There are only very limited situations in which we can remove folks from eligibility. And so that has meant that our eligible numbers have climbed throughout the pandemic, and are now at the highest they have been because we can not remove those folks from the roles. That is about to change. Congress has now put a schedule in place. So as of April 1, we can start removing those ineligible beneficiaries from the roles. And that is going to be a massively complex effort because we will be redetermining the eligibility for more than 400,000 Arkansans.


White (DHS): As we’ve gone through the pandemic, this is one thing we’ve done that not all states have done. We have continued to process eligibility. We continued to reach out to clients and say, “Send us your updated information.” And when we can find them eligible we do. So that’s put us ahead of a number of other states. But we still have these 400,000 Arkansans who have– either we have information that shows they’re not eligible, or they have not responded to us to give us the information we need to show that they’re eligible. And so as a result, their status is in question. And so we’ll be starting that process here very soon, working between now and April 1 to send the initial notices, and then as of April 1, folks will start coming off the rolls. And so that means that members, you will be getting calls. I will just tell you that when people go to the doctor and find their Medicaid eligibility is closed out, they are going to call you. And so when that happens– well, certainly you can reach out to the house constituent staff, but you’re also welcome to reach out directly to us. As we mentioned, Ms. McDonald oversees constituent services for us. We also have Shelby Welch in our office who is the day-to-today contact for constituent services. They will work with you. They will help track down the situation and see what’s going on and do whatever we can to assist that constituent. And I will also tell you, selfishly, that’s also good for us as an early warning system. Because there are times when we get a referral from a legislator about a problem, and we find after digging into it, we’ve got 20 other people who have the same problem. And so we encourage you, if you get calls from constituents about this, please send that to us, let us work with them, and see what we can do to resolve that situation.


Putnam (DHS): And we are going to provide this committee and the Senate Public Health committee with a timeline, a list of contacts, and a brief bulleted list of talking points just for your awareness so that you know what’s happening, and when it’s happening, and who to call.


Mann (DHS): And just to wrap up on the public health emergency, all 1.1 million Arkansans will be determined in the six months. So we’ve already started that paperwork and the first mailings will go out in February for redetermination decisions for April 1st, and we’ll continue on until we have redetermined everyone.


Putnam (DHS): Extra staffing. Extra staffing.


Mann (DHS): Yes, the extra staffing. So we are anticipating a surge in redetermination processes, and appeals, and hearings, and we’re looking at our options between staffing and contractors on how to handle that to remain timely. So thank you.


Rep L Johnson: Thank you, are y’all finished with the presentation and ready for questions? Representative Eubanks, you have a question.


Rep Eubanks: Thank you, Mr. Chair. With regard of redetermining their eligibility, are these folks going to have enough advance notice and a transition time in order to deal with that?


Mann (DHS): Yes, sir. What we try to do on the MAGI population is we try to send notices beginning at 90 days prior to a decision being made, and we send up to two reminders and multiple points of contact. So we do try to work with 90 days. In addition to that, on long-term care, we start the process 120 days out before their redetermination date. So we do try to build in plenty of time for that. That’s also why we’re anticipating a surge in activity and trying to look at staffing.


White (DHS): And two other points I would add, one is that for individuals who are in nursing homes or who are receiving in-home care through the AR Choices waiver, we do provide them some additional time. Once we’ve issued that notice of closure they have some additional time before their services stop. So they’ve got time to get noticed, get it addressed, and get that taken care of. And then if they do appeal, any Medicaid beneficiary can receive services while their appeal is pending. And so if it’s a problem– if they get a closure notice and they dispute that, they need to send an appeal in. And particularly, again, for those long-term care categories, on those, we automatically continue those benefits if we get an appeal notice from that beneficiary.


Rep L Johnson: Representative Ladyman, you have a question.


Rep Ladyman: Thank you, Mr. Chairman. I know we anticipated that we would not have to do this for the public health emergency until July 1. And I know that you all had a plan to do that. And when they passed the Consolidated Appropriations Act of 2023 and they decoupled, that brought that up to April 1st. So my question is, do we have adequate– I know you mentioned staff, but I mean, can you adjust that program to be able to do what was planned for July in April?


Mann (DHS): Yes, sir, that’s exactly what we’re trying to adjust right now, and working with Mary Franklin with county operations and our contractors to move everything up. We are ready to send those notices in February for the first round. And we’ve divided the population into categories to try to address that. And more than happy– we mentioned to Chairman Johnson that we would bring Mary with us and we would do further details in the outline and the timeline in contact information at the pleasure of the committee.


Rep Ladyman: Okay, another question, there’s a step down on what we pay or what the federal government will pay– they currently pay 6.2. And then they step that down quarterly to 5%, second quarter, two and a half percent, third quarter one and a half, fourth quarter. So we knew that this would cost us a lot of extra money. But is this change going to affect budgeting? I mean, do we have adequate money in the reserve to take care of this with this different timeline?


Mann (DHS): It has changed. And so by decoupling it, it has allowed us to do a little extra planning and to be able to look at the budgeting because now they’re graduating the money down each quarter as opposed to just cutting it off at the end of the quarter. For a specific answer to the budget question, we are still looking at it. I’m trying to get to some of those very questions and answers that you are asking.


Rep Ladyman: But it appears this could be beneficial instead of a negative?


Mann (DHS): I think it’ll be a combination because the money will graduate down that we will be able to claim. But it also allows us the six months to do the redeterminations without completely cutting off the additional funding. I just don’t have the delta on what that number is yet.


Rep Ladyman: I understand. Thank you.


Mann (DHS): Yes, sir.


Rep L Johnson: Representative Rose, did you have a question?


Rep Rose: Yes, thank you, mister chair. Excuse me, do you have an estimate on how long the appeal process would take? Any kind of ballpark?


Mann (DHS): I do not at this time. We expect a surge.


White (DHS): I will say, if my memory is correct, there is a limit on how long we can take for an appeal, and I believe it’s 90 days, is the time within which we have to process that appeal. And I’ll double-check that and correct if that’s not right. That’s my memory.


Rep Rose: I have a follow-up.


Rep L Johnson: Yeah, certainly.


Rep Rose: Kind of along a different vein, have you considered any type of a PSA campaign letting people know because, I mean, I know how postal service communication can be with folks. But I mean, television, radio, social media, any of those means. What are ways we’re going to let people know the benefits they’re heavily relying on are about to maybe leave?


Mann (DHS): Yes, sir. We do have a communications plan that several individuals in the agency have been working on.



Mann (DHS): For several months, if not a year. It does involve interaction with our community action agencies and county offices and other stakeholders. But in addition to public service announcements, TV, social media, mail, and we’re looking at all other options. We can get you a detailed list and a copy of the communications plan if you would like.


White (DHS): And if I can switch to two quick things, one, we did a communications plan and a PSA effort back in the fall to encourage beneficiaries to reach out to us and update their contact information. Because that’s one of the big worries is we will send them a closure notice and it’s to an old address. And that was very successful. We had more than 100,000 Arkansans reach out to us, and update their information. So we’re very pleased by that. We’ll be repeating many of those efforts in the coming months. And I know our director told me earlier we just signed an additional $75,000 budget for one piece of this.


Rep Rose: I would like to receive that plan. And do you know when you’re planning to start that?


Mann (DHS): I think if I think it’s February 1, but we’ll come back to you with that.


Rep Rose: Thank you.


Rep L Johnson: Are there any other questions from committee members? Yes, Representative Perry.


Rep Perry: Thank you, Mr. Chairman. I don’t know where to start. So we’re actively involved. Our insurance agency is actively involved in helping people with all this. And I mean, Lori’s been a rock star. I mean, we reach out to her quite often. And she helps explain. But looking at the eligibility limit. Has the federal level been raised for 2023? Because I know you know with the cost of living increase, everybody’s excited about, but sometimes that will knock that person on Medicare and social security out of a program for five bucks. A $5 increase costs them a hundred and something dollars a month on the back end.


Mann (DHS): Yes, sir. We anticipate the federal poverty guidelines being updated approximately March 1st, then we put them into our system to be effective April 1st. So we’ve not received them to my knowledge yet.


Rep Perry: We talk to so many clients when we’re enrolling them in the AR home and we ask them who their primary care physician is. And they say, “I don’t have one. I always go to the ER.” And UAMS, back before the private option. I was here when we implemented that, UAMS had close to $100 million in uncompensated care. I think what will happen for the short term is when these people get kicked out, they’ll quit going to their primary care Doc and start going back to the ERs, which are already backlogged. So I’m hoping that doesn’t occur and hope we can figure out how to implement the contact procedure to get these people taken care of.


White (DHS): And I will say one thing we will do is that we can work with folks. If they are not eligible, in many cases, they may be eligible for the marketplace. So they can get subsidized coverage through the marketplace, which may have little or no premiums. And so we certainly will point them to that. So we can help get them that continuation of coverage.


Rep L Johnson: Thank you. Representative Ladyman you’re recognized for a question.


Hiring freeze

Rep Ladyman: Thank you, Mr. Chairman. Madam Secretary, I had a question for you. Excuse me. With the Governor’s freeze on hiring, I’ve got lots of calls, I’m sure other members of this committee has gotten calls about the human development centers. The turnover there is 100% sometimes in a year. And I talked to one of the directors this morning and asked her if she was doing okay with hiring because they’re constantly hiring. And they said that they were doing okay, but the RAs were having trouble. Because they constantly lose those people to hospital or whatever. And this could become a critical, very critical situation. We’ve got a hundred people in these facilities, five of them around the state. And they need care all the time. So do you know if the Governor or have you all had that discussion about releasing that hiring freeze for the human development centers? And I mean, that needs to be done right away.


Putnam (DHS): We have had that conversation with both the Governor’s Office and OPM. We are in the process of identifying for them not just the HDCs, but other categories of essential workers that we really need to pay attention to at DHS, frontline social workers being among those are child care, family care services workers, so there are several categories that we’re in active discussions with both Governor’s Office and OPM to problem solve and be able to move forward with those.


Rep Ladyman: Well, I would ask that you reach out to some of us that are very close to these facilities. If you have questions about their needs because they’re great.


Putnam (DHS): Yes, they are. Thank you.


Rep L Johnson: Are there any other questions for the committee? Seeing none, thank you so much for taking the time to come and present. Appreciate you.


Putnam (DHS): Thank you.


HB 1137 Allows cities to burn vegetation 

Rep L Johnson: Representative Cavenaugh, are you here and ready to present your bill? Representative Cavenaugh, you’re recognized to present your bill.


Rep Cavenaugh: Thank you, Mr. Chair. I apologize for running late, had another bill running.


Rep L Johnson: You dovetailed right in on time. It was perfect.


Rep Cavenaugh: Thank you. Members, Fran Cavenaugh, representative of District 30. This bill is a simple one-page bill. It actually adds two words into the statute, which basically says that cities now will have the ability to do vegetation disposal. Currently, cities do not have the authority to do a burning of their vegetation. This will allow them to do so. And that’s it.


Rep Ladyman: Yes, I have a question.


Rep L Johnson: Representative Ladyman, you’re recognized for a question.


Rep Ladyman: Representative Cavenaugh, we had discussion and I asked if you had talked with ADEQ about this if they had concerns about this. And the reason I asked you that question, we’ve had two cities in the past that were non-attainment cities, which means that particular matter was over the EPA limit. And those cities are Little Rock and West Memphis. And West Memphis is always on the border because of the city of Memphis across the river. So burning adds a lot to the particulate matter in the air. And I think we need to talk to ADEQ about this and see if they can study the impact or no because we do not need to have non-attainment cities in Arkansas. There’s a lot of cost to the cities, and I know you’re talking about saving the cities, and I’m all for that, saving them money and reducing what goes into landfills. But some of these cities, like West Memphis and Little Rock, could incur a lot of extra costs if they go over this attainment level on particulate matter. So have you had this discussion with ADEQ?


Rep Cavenaugh: ADEQ mentioned that they may have an issue with that, but here’s my take on that Representative Ladyman. Just because you’re giving the city the ability to do it doesn’t mean I said he has to do it. And if you got cities that know they’re in that particular area, the leadership should be able to make that decision. Currently, if they call ADEQ and ask for a permit to burn, they’re able to burn. So all this does is allow them not to have to call ADEQ and be able to burn.


Rep Ladyman: But I think many cities are not aware these are federal EPA standards we’re talking about, not state. And a lot of times cities are not aware of that. That’s why we have ADEQ to do that. I think they need to be at the table and I’d like to hear their opinion on this bill.


Rep L Johnson: Is there someone from ADEQ here that would like to speak? You can introduce yourself to the committee, state your name. Thank you.


Witherow (ADEQ): My name is David Witherow. I’m with the Division of Environmental Quality. I’m the office of air, associate director.


Osborne (ADEQ): And I’m Caleb Osborne. I’m the chief administrator for the environment or the DEQ director.


Rep Ladyman: Gentlemen, I just wondered if you could talk about this and talk about, are there potential problems or is it okay? What might be the issues with this bill?


Witherow (ADEQ): To your concern about particulate matter, in fact, the EPA is proposing to revisit the particulate matter standard. And with the way the EPA has been, we are pretty sure they’re going to drop the standard, possibly significantly. And two of the areas of concern that we’re watching very closely are Crittenden county and Pulaski county that could potentially go into non-attainment if they drop it too far. And of course, as you’re aware, open burning tends to add heavily to the particulate matter in whatever area they’re burning in.


Rep Ladyman: What about stump dumps? I mean, is that something that might be affected by this? And it would be down the road, but we just spent millions of dollars up at Bella Vista trying to put out a stump fire under the ground. And again, what causes that is if they don’t landfill them properly, and then years later, you have spontaneous combustion, and you can have fires that you can’t put out. And I mean, is that a concern with cities doing this? Or not? Is that not a concern?


Witherow (ADEQ): Potentially, sir. Depending on the way you interpret vegetative debris, stumps, chipped wood could potentially be interpreted as vegetative debris. So this would inhibit the department and the state’s ability to deal with those problems because it would end up being something we wouldn’t regulate at all.


Rep Ladyman: So if we could define that better, that would alleviate that potential problem, maybe?


Witherow (ADEQ): Potentially.


Rep Ladyman: Okay, thank you.


Rep L Johnson: Representative Wooldridge, you’re recognized.


Rep Wooldridge: Thank you, Mr. Chair. Representative Cavenaugh, just a point of clarification. Are these things that the individuals could burn had the city not picked them up and just burning them in mass?


Rep Cavenaugh: Yes, currently citizens can burn these. So rather than each citizen having a burning, this would allow the city to do that. So it’s not adding anything that is currently not being burned.


Rep Wooldridge: So I guess for clarification from ADEQ, what would the difference be if they burn individually versus by the city at one time?


Witherow (ADEQ): I think the concern with the city burning is you end up with a large amount of this and potentially a stockpile, which would potentially end up with a rather large source that we can’t predict how that’s going to affect air quality standards.


Rep Wooldridge: So a large fire impacts differently than the same amount of small fires.


Witherow (ADEQ): Potentially, yes, sir.


Rep Wooldridge: How is that?


Witherow (ADEQ): Well, when you create a gathering place, I think we believe that this could burn potentially all the time. The way we do it right now with storm debris is the department has the ability to kind of know when these things are happening and going on. Without that ability, we wouldn’t be able to have any curtailment or any kind of knowledge of the ongoing.


Rep Wooldridge: So then the issue becomes an ongoing burn site, not the air pollution.


Witherow (ADEQ): Well, the ongoing burn site would impact the ongoing air quality.


Rep Wooldridge: Because the small fires would not be ongoing.


Witherow (ADEQ): No sir, we don’t believe so.


Osborne (ADEQ): Well, one other thing I could add to this is that some of this material would also– there’s a solid waste issue, which I think is one of Representative Cavenaugh’s concerns. It has to deal with the cost of the pickup and collection. But there are other pieces of our regulatory program this would impact. That’s where the Representative Ladyman mentioned stumps and limbs. That is typically collected for placement in landfill. There are other pieces of the program that this would impact, into his question that he asked earlier about further definition would be beneficial because there’s just some of this material that creates additional environmental impacts for burning it. And as David mentioned, kind of the scope and scale of how large these stockpiles are, the fire bill of this that Representative Ladyman mentioned, that was an illegal dump site. But what had happened is a large amount of debris accumulated over a long period of time, eventually ignited, which there’s some issues with that as well. But it was an unpermitted disposal site and so some of the definitional things we would like an opportunity to work through or would like to get some more clarity because it just touches a lot of other aspects of our programs.


Rep L Johnson: Are there other questions? Representative Miller, did you have a question?


Rep Miller: Yes, thank you, Mr. Chair. Representative Cavenaugh, this may seem kind of simple, but are you just trying to bring about a simple fix for the towns in your district that you work for?


Rep Cavenaugh: Yes.


Rep Miller: And you’re not trying to represent and work for the EPA.


Rep Cavenaugh: No, I’m trying to represent my constituents that elected me.


Rep Miller: Fair enough, thank you.


Rep L Johnson: Are there any other questions from the committee? Seeing none, has as anyone signed up to speak against the bill. See a Mr. Richman? Are you here? You signed up to speak for the bill, if you could approach the table and introduce yourself for the committee. Just announce your name and who you’re with, please. Thank you.


Richman (Municipal League): Yes, my name is Lainey Richman. I’m with the Arkansas Municipal League.


Rep L Johnson: You’re recognized.


Richman (Municipal League): So it won’t be a whole lot of new ground. I do think it’s a fairly simple bill. But this came to us to help draft out of some of the cities in northeast Arkansas as you can imagine with Representative Cavenaugh here. And their main concern was just picking up all the debris that they have to pick up, paying to get it to the landfill, and then paying those fees. I think they run the landfills up there. Someone can correct me on that. But currently, residents can burn their limbs, burn the debris, the farmers up there, I believe, can burn their fields if they need to. And by and large, the city just wanted to be on the same playing field without passing those additional costs onto the citizens of their city. I’d be happy to take any questions.


Rep L Johnson: Are there any questions from the committee for Mr. Richman? Yes, sir. Representative Rose.


Rep Rose: Do you have any thought on what the potential drawbacks would be? What comes to mind for citizens or municipalities?


Richman (Municipal League): For the municipalities, they may be getting some more calls from the citizens to engage in this behavior. I think the citizens would probably appreciate quicker debris pickup from their yards. For the citizens, I could see someone complaining that there’s more smoke if we’re doing this in an area that’s residential, but I don’t believe any city would be engaging in that type of behavior, but I could certainly see that possibly coming up.


Rep L Johnson: Are there any other questions from the committee? Yes, Representative Wooldridge.


Rep Wooldridge: Thank you, Mr. Chair. How are cities currently disposing of these items? And what’s the associated cost with that versus this?


Richman (Municipal League): Currently, it’s my understanding and I don’t do what I haven’t seen in the numbers, but it’s the cost to literally haul this degree, which I believe is fairly sizable because it’s not easily compacted in any way to the landfill wherever that is. And then you have to, I believe the landfill pays for some amount of space and pods. So the landfill is paying for it, and that’s run by the cities of northeast Arkansas, my understanding. But then it’s the cost of transportation, the cost of the workers to pick it up and get it out there. That’s my understanding. I won’t claim to be an expert on the costs associated though, sir.


Rep L Johnson: Representative Ladyman, you’re recognized.


Rep Ladyman: Thank you, Mr. Chairman. Just try to clarify some members are saying that burning this in one big pile is the same as in individual piles. But wouldn’t the volume go up? Because isn’t some of this going to the landfill now and not being burned?


Richman (Municipal League): I would suspect so, sir, yes.


Rep Ladyman: So, I mean, I know it’s individual cities’ ability to do it. But the volume could, I would say probably would, increase– the volume of material that was being burned would probably increase. Would you agree?


Richman (Municipal League): I would agree, sir.


Rep Ladyman: Thank you.


Rep L Johnson: Any other questions from the committee? Seeing none, do I have a motion? Motion do pass. Second? All those in favor? Discussion? Representative Ladyman, you’re recognized for discussion.


Rep Ladyman: Representative Cavenaugh, I like the idea. I love to save money for cities, but I mean, I have many concerns about this. I believe the term needs to be defined, and I believe that you need to sit down with ADEQ and make this bill a better bill. I think it’s a good bill and a good idea, but I really have concerns and I can’t vote for it because I have concerns right now about a lot of things when we’re talking about pollution.


Rep L Johnson: Is there any other discussion from the members? Representative Womack, you’re recognized.


Rep Womack: Thank you, Mr. Chair. My immediate concern when I read this bill the other day was we’re granting the cities, municipalities, a right that your average everyday citizen doesn’t have. Because I was pretty sure that most of these cities have ordinances against burning this and burning that. And so I instantly got on the phone with some code enforcement people and fire stations. Anyway, truth is, I think it’s exactly as Representative Cavenaugh has presented it. It’s not allowing the city to do anything extra. All these materials that can be burned under these definitions can currently be burned by individuals. So to me, it just makes sense to allow what’s going to be burned anyway to be burned more efficiently. If the city needs a little help, I don’t see what it hurts because there’s no expense of the taxpayer and we’ve not granted on any special permission. At least the cities that I talked to in my district.


Rep L Johnson: Any other discussion? We have a motion on the table do pass. All those in favor say aye. All those against? Aye’s have it.


Rep Cavenaugh: Thank you committee.


Rep L Johnson: Congratulations, Representative Cavenaugh, your bill is passed. Committee members, if you allow me a few minutes for some housekeeping just briefly. First of all, we have a lot of bills on the agenda that tie into a common theme of maternal-fetal medicine issues. A lot of these I anticipate will have some of the same people coming to testify. There’s at least four or five, maybe six on the agenda now. We’re going to try to potentially have those on special order just because there’s going to be a lot of the same people coming in to testify. Right now we’re looking at the 31st of January as the day to do that. That’s assuming we get the fiscal impacts back on the ones that are setting in the fiscal impact statement. If you have people who or know members that have bills that fall into a category that’s similar to this theme, it would be great to go ahead and file those so that we can maybe hear those at the same time because of the similar nature of the theme of similar people here that are going to be here to testify.


Rep L Johnson: The paper, it may be one and done, guys, I’m going to do the best I can at it. When I said yes to that, I had no real thought to how many committees might want that same privilege offered. Looking back retrospectively in my tenure here since 2019, we haven’t had paper bills provided. There’s been a tablet in 2019. Last session we all were working off our phones, off our own personal devices. My understanding is members have been provided access to their laptop or tablet, this is still a work in progress. I can’t commit to having paper bills every time we’re here, but I did commit to this time. So I wanted to try to hold to that commitment. Representative Wardlaw, do you have a comment?


Rep Wardlaw: Yes, sir. I think I would amend my request to the agenda only.


Rep L Johnson: Okay. So we’ll try to do that. The challenge that for me is that and again, this is where I’m trying to encourage members. We’re going to try to run a clean agenda. We’ll try to look at trying to be clear on what we’re thinking we’re going to be able to get to, but everything’s going to fall to the agenda. So there’s a potential there for us to have multiple bills that are sitting on the agenda multiple days that we’re running copies for, that we’re not going to hear. And we’re just going to keep running these copies on bills we don’t hear. So I hear your amendment to recommendation. I can’t commit to that right now, but we’ll keep working on this process and hopefully come up with a process everybody can live with and be happy with.


Rep L Johnson: The only other comment I’ll make, there’s going to be topics come up that we’re all going to have interest in, where we’re going to want to call an agency or an association or somebody at the table to give us information on the topic. And I’m open for discussion on this issue, but I like the idea. If we’re going to have a topical informational type meeting. If a member wants to come to me and say, “Hey, I’d like to have DHS to come and discuss a specific topic or Department of Health or Workforce Development.” Whoever, come and bring that to me. I will try to set that as a special meeting, perhaps at a different time than our normal meeting. So that everyone can know and be aware, this is a meeting where we’re going to come and hear information, not hear bills. That way we don’t have a situation where we’re trying to hear information. Everybody has a lot of questions. I want everybody to get their questions answered, but we’re also sitting with an agenda with 10 or 15 bills on there we’re trying to get to.


Rep L Johnson: So without objection from the committee, my approach, I think, will be that if we’re going to have an informational meeting, I will try to set that at a separate time and we’ll send that information to everybody, we’ll announce the meeting. So everybody can attend. And I would encourage you if you want those kind of meetings to come bring it to my attention. We’ll set that up. Does that sound okay with everybody? Does anybody have any questions before we adjourn? All right, meeting adjourned. Thank you.