Legislators are moving ahead with a financing plan that allows an additional 500 people with developmental disabilities to move off a waiting list and get services that will help them live more independently.


During this year’s regular session lawmakers approved Act 50 and Act 775, both designed to help people with development disabilities. Act 50 allows $8.7 million from a state settlement with tobacco companies to be used to match about $20 million in federal funding. The funds will help 500 people get services. The waiting list now has about 3,000 people on it.


Act 775 is a more comprehensive change to the overall system of paying for services, with the intent of eliminating excessive and unnecessary costs. The act creates a Provider-led Managed Care system.


Usually providers are non-profit organizations that receive Medicaid reimbursements for treating and caring for people. The state provides about 30 percent of the cost of care and the federal government provides 70 percent.


Besides reimbursing private providers for home and community services, state government also operates long term care residential facilities for people with the most severe developmental disabilities. They’re called Human Development Centers and they are at Arkadelphia, Booneville, Conway, Jonesboro and Warren.


Arkansas tries to provide a balanced array of services across a spectrum that includes institutional care for people with the most severe disabilities, as well as appropriate levels of support for people who want to live with their families or in a group home.


Under the model created by Act 775, providers will become responsible for the care and treatment of about 30,000 Arkansas residents whose medical needs drive up Medicaid spending. Under Act 775 care-giving organizations will be allowed to form what will be known as a Provider-led Arkansas Shared Savings Entity, or PASSE. They will assume the risks and share in the cost savings of treating people whose medical needs are expensive. Those categories include mental illness, substance abuse and disabilities.


One goal is to lower costs by eliminating gaps in care, thus reducing the number of cases in which acute and emergency care is necessary.


According to a consultant hired by the legislature, the majority of Medicaid spending is for the elderly, people with disabilities and people with mental illness. For example, Medicaid serves more than 450,000 Arkansans over the age of 65.


According to the consultant, the Human Development Centers care for about 925 people with developmental disabilities at an annual cost of $159 million. The state provides support services to another 4,200 people with developmental disabilities to help them live in their home communities, at an annual cost of $197 million.


Last year the state and federal governments spent more than $6.5 billion on the Arkansas Medicaid program, according to the Department of Human Services, which administers it.


Legislators are pursuing another strategy for holding down total Medicaid costs, which is to rely on independent assessments of the medical needs of people who apply for services.


More than 12,300 providers participate in Arkansas Medicaid. They include physicians, pharmacists, dentists, hospitals, vision care providers, medical equipment companies, various types of therapists and nurse practitioners.