ARHOME Plans are Secondary to all other plans pursuant to Medicaid's Payor of Last Resort Rule

Hugh McDonald SECRETARY OF COMMERCE AID 17..4li'"" * BULLETIN NO. 10-2024 Alan McClain COMMISSIONER, ARKANSAS INSURANCE DEPARTMENT TO: ALL LICENSED HEALTH INSURERS, HEALTH MAINTENANCE ORGANIZATIONS, HOSPITAL AND MEDICAL SERVICE CORPORATIONS, AND OTHER INTERESTED PARTIES FROM: ARKANSAS INSURANCE DEPARTMENT DATE: JULY 24, 2024 RE: ARHOME PLANS ARE SECONDARY TO ALL OTHER PLANS PURSUANT TO MEDICAID'S PAYOR OF LAST RESORT RULE The Arkansas Insurance Commissioner ("Commissioner") issues this Bulletin to advise health insurers that Arkansas Health and Opportunity for Me ("ARHOME") plans should only be used to pay claims for covered benefits when all other plans under which an insured has health coverage have paid first. In 2013, Arkansas obtained approval from the Centers for Medicare and Medicaid Services to use Medicaid funding to purchase private insurance for its newly qualified adult population through a Section 1115 Demonstration Project. Arkansas has subsequently applied for two more Section 1115 Demonstration Projects which enable Arkansas to use Medicaid funds to purchase individual qualified health plans coverage from the Health Insurance Marketplace. The plans electing to participate in the program to provide health insurance coverage to the adult expansion population are not excluded from state and federal requirements that Medicaid be the payor of last resort. The General Assembly has declared that payments made by the Medicaid medical assistance program are intended to be supplemental to and not as a replacement for payments from other sources. The General Assembly recognizes that the Medicaid program "is the payor of last resort to supplement and not supplant other sources which are or may be available to any individual, except when federal requirements under Title V specify otherwise." Ark. Code Ann. § 20-77-101(a). When Medicaid beneficiaries have one or more additional sources of coverage for health care services, Medicaid's third-party liability rules apply, and Medicaid funds pay last. Because the Department considers plans participating in ARHOME to be subject to Arkansas Department of Commerce Arkansas Insurance Department 1 Commerce Way, Suite 102 • Little Rock, AR 72202 INSURANCE.ARKANSAS. GO V Medicaid's third-party liability rules, these plans should only pay for health care services when all other sources of coverage have been exhausted. Insurers offering ARHOME plans and coordinating benefits pursuant to Department Rule 21, Coordination of Benefits-Accident and Health Insurance Policies, are advised to seek payment from tortfeasors when such benefits are owed and to also coordinate the benefits of any applicable plans covering the member such that the ARHOME plan is secondary to all other plans. The Commissioner expects insurers not currently coordinating benefits as described in this Bulletin to be in full compliance by Plan Year 2026. For questions related to this Bulletin, please direct all inquiries to AID's Legal Division at (501) 371-2820 or email insurance.legal©arkansas.gov. Alan McClain Arkansas Insurance Commissioner 4y4 Date