Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and KUAR FM 89.

Hello again, everyone, and thanks very much for joining us.

Up top tonight, it's the multi-billion dollar health care program for the low income.

The state and federal combined we know as Medicaid.

Big changes are at hand.

The federal policy that essentially protected enrollment during the COVID pandemic has expired, exposing tens of millions of Americans and tens of thousands of of Arkansans.

Scores of thousands to perhaps the loss of medical insurance coverage and the special financial aid to health care institutions providers.

That's at an end as well.

Also, the Sanders administration is asking Washington's permission to impose a work or volunteerism requirement on Medicaid's expanded coverage enrollees.

So much to cover with Christie Putnam, the new secretary of the State Department of Human Services, and Janet Mann, the Arkansas Medicaid director.

To both of you, we thank you very much for coming on board.

If I can, let's begin with the with the Sanders administration's work requirement that it that it's asking permission from Washington to impose.

What guarantees do we have?

What makes us believe that it can work, that it will be successful?

Well, we are looking at this as a workforce development component to Medicaid as a way to really connect people with access, better access to opportunities.

In conjunction with our workforce services statewide, working with community organizations who have programs in place for training programs, volunteer programs, all of the kinds of workforce supports that will help individuals who may not know that an opportunity exists out there, connect to those resources and move not just into a job, but a career.

We're really looking at this as an economic stability initiative.

But one criticism of the approach is that it is being used as an economic incentive when it is not designed.

Medicaid is not designed to do that.

It's designed to provide health care.

Your response?

So our approach is to give the opportunities for additional training, volunteerism to our beneficiaries to help them seek additional opportunities.

So while it is an economic and workforce development, it also gives them some career and success coaching to help with their health care and is voluntary.

So they will not be penalized if they choose not to participate.

Well, the.

To what extent, if any, is the policy is the way we're being driven by fiscal incentives other than health care.

For example, the administration's plan to offer for public education, for expanded prisons, criminal justice reform, and also for tax cuts.

Is this is that a driving factor?

It's not the driving factor.

From a fiscal perspective, it's really on the employers across the state who are in need of a number of highly skilled individuals to come to work in their in their businesses.

So that's the fiscal incentive.

It's not on the state side as much as it is on the employer business side.

What kind of outreach are you going to do?

Outreach will vary and we will seek partners across the state with our sister agencies.

We will also be working with other advocate agencies and organizations within the in the business community to promote this.

I think some of the lessons that we've learned from other outreach campaigns is the more we communicate, the better.

So it will be within state government and out of government with our partners and our providers and our beneficiaries.

The qualified health plans already as part of their programing.

The waiver was approved to allow them to provide economic incentives for their participants and connections to these kinds of resources.

So we will continue to lean on them and ask them to take further responsibility.

It does benefit them to do so.

They have an interest in this because when individuals move out of the Medicaid portion of a qualified health plan, they can move into their commercial side, which is offered on the federal marketplace and which is actually sometimes a richer benefit, and it's an enhanced payment to providers under the plan as we understand it.

They're going to get medical coverage provided they reenroll.

They're going to get coverage anyway.

But is the loss of the expanded coverage and the revision to traditional Medicaid, is that going to be incentive enough?

We think it will be a good incentive because staying in the qualified health plan or moving to a different type of coverage on the federal marketplace, but keeping their same health plan or same insurer will ensure continuity of care and continue that incentive to broaden their horizons and seek additional training and classes.

We're also looking at simply less Medicaid spending, are we not?

Yes.

The answer is if we have individuals who move out of Medicaid coverage because they find employment and have employer covered insurance, then that would be a reduction to the Medicaid expenditure by those individuals who are successful in moving into employer sponsored insurance.

Well, across the country, millions of Americans are going to lose coverage, Medicaid coverage, because that federal rule that prohibited dropping them during the pandemic, dropping them for Medicaid, expires at midnight on March 31st.

DHS wants to encourage everyone who is on the program, either the extended program or traditional Medicaid, to make sure that they are still enrolled, make sure check their eligibility.

Do we know do we have an estimate of the likely Arkansas falloff in enrollment?

So national estimates are 15 to 30% of the fee for service population could lose their eligibility in the redetermination process.

We have been very cautious about applying hardening measures to that because until we start enrolling, we really don't know how that will apply to Arkansas.

And we do estimate approximately 50,000 of our home participants could move to other coverage either on the federal marketplace or employee sponsored health insurance.

There is some concern among rural hospitals.

Our understanding is that may be already on the fiscal edge that the impact could be absolutely ruinous to them.

Your response?

There's no doubt about that.

That has been in the press and that has been widely discussed.

Medicaid is approximately a third of the payer source.

You also have Medicare and commercial insurance.

So while there is concern and we are trying to address it from the Medicaid portion, I think it's an overall concern for the state to work with those hospitals and seek ways to do more with less.

And Medicaid has a portion of that responsibility.

Do you see there are I understand there are some rumblings to quote, to quote a source.

There are some rumblings about possibly the state moving to managed care through Medicaid.

Is that on the horizon?

Do you see that?

And the foresee is that in the foreseeable future?

No, sir.

I think we are a new administration and we are reviewing and looking at all of the programs within the Medicaid health care delivery system.

And as I have been telling providers and beneficiaries and other interested parties, we are looking at everything.

Everything is on the table.

Nothing's been ruled in and nothing has been ruled out as of April 1st anywhere anyway.

There are some reductions and Arkansans need to understand that there will be the first wave of people who are no longer eligible to remain on Medicaid will begin rolling off on April 1st.

Yes, sir.

And we are doing our regular redeterminations and then the extended population.

We will spend the next six months really determining all of the Arkansans on Medicaid, which is approximately 1.15 billion Arkansans today.

That number changes every day, but we will do that over the next six months.

We are doing a lot of communication and working with our providers and our beneficiaries to help them do that redetermination or the recipients that are either now on traditional Medicaid or in the expanded pool.

What is your message to them?

What do they need to know?

Like right now?

Right now you're going to be getting mail that says please rate determine.

Please send in your information.

We need them to either call or respond in kind with the email.

And if you have not updated your information, please do so either through your local office or through the mail.

Yeah, that underscores the need for outreach, does it not?

An extensive outreach.

They don't.

A great many people, but probably do not know that they are losing eligibility or are in danger of losing it imminently.

Well, we have spent a great deal amount of time working on our unwinding plan over the past year.

The the staff at DHS have developed a pretty detailed unwinding plan that has a a large outreach component to it with our beneficiaries, with our providers, with paid advertising, with social media.

We've even put a bulletin board, digital bulletin boards in some of the doctor's offices to try to get the message out in addition to phone call and contact information.

And then the mailings at 120 days or 90 days before redetermination.

So we we are looking at all unique outlets to communicate.

Redetermination is coming and it is here.

So outreach really started before the end of 2022, and it's called Renew Arkansas.

And it's been an extensive outreach campaign.

To your point, you're absolutely right.

And our team has been engaged in the Renew Arkansas campaign since before the end of the year.

But that is only beginning.

The outreach is really, you're saying only beginning?

No, the outreach has been ongoing due to let people know that they need to make sure their information is correct in the system, that their address is correct, that they have read the notices.

If they don't understand something to go into one of their offices to meet with someone at DHS that has been ongoing.

The the additional outreach at this point is letting people know that the first wave of possible ineligible periods is coming up April 1st.

We have to indivior Miss Putnam as man, thank you very much for being with us.

We're simply out of time.

Please come back soon.

We would like an update.

Thank you very much.

We look forward to it.

All right.

Good.

Thank you.

And we'll be back.

And we are back.

Gambling on thoroughbreds and greyhounds for a century or longer.

It was allowed by the Arkansas Constitution.

Then came a state lottery, followed by casinos.

Three are up and running.

And now under the egis of those three online wagering benefits to the expansion of gambling shore tax revenues, college scholarships, jobs, vendors, but liabilities as well as state government recognized by creating a hotline for Arkansans whose wagering has become an addiction for whom gambling is out of control.

Joining us now, Venus Schneider, president of the State Problem Gambling Council, and Dr. Buster Lackey, a licensed counselor who leads the Arkansas chapter of the National Alliance on Mental Illness.

We also will ask the lucky audience to know that we reached out to two of the Arkansas casinos to seek a representative here, and we were unable to secure anyone in time for the broadcast.

But thank you both very much for coming in.

March Madness almost over, but April Madness is right here.

By Monday night, there will be a new national champion.

The tournament is the biggest sporting event since online gambling began in Arkansas.

Are we seeing a surge in wagering?

We are seeing a surge.

And exactly why we have problem gambling month Awareness month for the month of March to accompany March Madness to bring and create that additional awareness.

We've seen an increase in calls over the years from the past data with the Arkansas Problem Gambling Council starting to take on more of those calls.

Even within the last month or so, we've seen about 800 calls, which is another 20% increase than previous months.

Europe, a fifth.

Another world.

Yes.

Do you expect that to continue?

I do expect it to continue with the insurgents of sports betting and the digital gaming that is also a part of our cause.

Well, Dr. Lucky.

Yeah.

You know, we've at the NAMI office, even we've seen numbers of our call on our help line increase with people with gambling problems.

And what it is, is mental health associated with the gambling increase, depression, anxiety.

Gilchrist Because what they're doing, you know, they're trying to offset the losses by illegal means, which are stealing whatever.

There's no one would question that there are some benefits, I think.

In February alone, almost $33 million in tax revenue from wagering in Arkansas.

And as we mentioned up top, you know, there are there are some jobs created.

And the casinos, the wagering establishment, they need vendors and all of that generates tax revenue.

But there's an economic downside to can we measure.

Have we been able to measure that?

Are there any measures of it so far?

We are working on that right now with the Arkansas Problem Gambling Council and also partnerships with local colleges and universities from social service programs to be able to create needs, assessments for social impacts for risk.

Why?

Well, you know, I think as far as the needs assessment, you know, a good a good determination for us is in my clinic, I'm seeing more people come in with gambling as the problem.

And then the secondary problem is the depression or some other, you know, mental health issue that's going on because of their debt that they're in now.

How does gambling work on the on the psyche of, you know, the neurons if you.

Yeah, well, you know, it's kind of like I've said this before and we talked about a little earlier before the show started, you know, it's like when you take that first drink, the first alcoholic drink, and there's it clicks the brain, it likes it, It feels good.

It makes you feel happy.

It sets all the the neurons.

Everything's firing up there that's supposed to be firing to make you happy.

And then you go into the casinos and it's, you know, lights and sounds and and the smells and everything that's that goes along with that.

The brain is receiving it as a pleasure sensor until you go home and realize that your $2,000 paycheck is Now you left it at the casino.

Right.

And then you still got rent and, you know, electric bills and whatever else to pay.

Well, the casinos are, of course, the nexus of online gambling.

And I you'd go it's filtered through or routed any way through it, through the casinos.

And I suppose we can we should credit the casinos for their contributions to national organizations for for problem gamblers.

We talked about how your inquiries were up 20%.

Can we put that in the numbers?

We can put that into numbers.

So you mentioned 800.

I think 800 or so.

Last year, we saw a total of about almost 5700 calls.

And we expect that to increase another 10 to 15% for this year.

What I am saying is a is a different level of call servicing for us.

People are asking more in-depth questions for not only for themselves but also loved ones.

And so as a problem gambling council, we hope to have therapists and counselors ready for both parties, for the the gambler and for the loved one.

Well, I was going to ask the inquiries that you get, the calls that you get.

Are they mostly from the gamblers themselves or from significant others?

They're mostly from the gamblers themselves, most of them.

But we have seen an uptick in calls from the spouses or other loved ones in the family.

Your phone rings and it's a problem gambler.

And he or she says what they say.

Hi, Can I get help?

What can I do?

I've lost it all.

Or we are about to lose it all.

And not only calls, they're also text.

We have a text information chat line that's available.

And we also they can send a confidential email to us directly.

And sometimes we get those that have lost it all.

And then we also have a referral system with Dr. Lackey and with NAMI, because you can see with the assessment or screening that there are some underlying depression or some other co-morbidities, as we call it, right?

That, you know, in the clinic side is actually just almost the opposite.

I usually get the family in first because they're trying to figure out how to help their son, daughter, husband, wife, whatever.

And right now I've got a lady that she she's coming in to see therapy, seek therapy because she's depressed.

And as I and she has insanity over stressing over the third of the month.

What's the third of the month?

That's when her daughter gets her once a month paycheck.

And it's a hefty paycheck.

She's a she's got a very good job.

But by the seventh of the month, she's out.

She's already gone through almost $15,000 of her salary that she's got.

And then, you know, grandma buys the child a pair of Nike shoes and all of a sudden, oh, the we lost him at the school.

We don't have a no more.

So now grandma is trying to figure out where's all the stuff and buying going.

Well now she's figured it out.

It's being hawked or sold marketplace online you know they're selling this stuff.

It is, I think, a widespread assumption that wagering problems, gambling problems typically are are found in the lower socioeconomic category.

Is it in your experience as a cut across demographic lines?

To an extent, far beyond that?

Oh, yeah.

Stereotype.

You know it it's the gambling problem.

Doesn't know a political party.

It doesn't know a social economic side.

It doesn't know a race, it doesn't know a class.

It's everywhere.

It's all across.

I've got several I mean, I've got two patients that I see that, you know, make barely minimum wage.

And I got some that make more than all three of us put together in the room.

And it's a habit.

It's addictive.

They like the they like it.

They like it until they leave and realize that they're leaving their whole check there.

And I think that's where it becomes a problem that we've got to you know, now this this grandmother, this mom has got to get her daughter to convince it's a problem.

Online wagering has that aggravated the problem as it made?

Well, it's giving you more clients anyway.

It has.

And it also has given increased accessibility to where everyone with the cell phone has a walking 24 seven casino in their pocket.

You got a slot machine in your right.

Well, you just look at college students.

You know it is it has jumped off the roof on the college students that are now in debt because of their online gambling.

And in fact, we have found that as young as 12 years of age is now proficient, 12, 12 is now proficient.

You said 12, you said 12.

You're not even a teenager yet.

And they they are very proficient in in the games, online games.

And in fact, we talked to one lady that called into the office and the the casino.

They were they got a marker or something that this child owes.

So it's like, how do how do you deal with that?

You know, and the when they try to reach out to the well, I've got another client that that executive at a large company and we sent her to a 30 day treatment program out of state and then she come back and she was working on getting the the going back to the casinos and saying, hey, you know, block me.

Yes, that's a solution.

Sorry, I can remember the name of that.

So now they tell her, Oh, you got to come here to do that.

And she said, I don't want to go there because I know if I walk in, I'm not going to self exclude.

I want to spend my check.

Yeah.

Is there a treatment protocol?

How do you go about helping somebody?

So there is a treatment protocol.

The first step is to ask for help.

And with that again, they can always a client or loved one can call the one 800 helpline number that's available 24 seven.

And from there they will have a friendly voice like myself or another person trained on the line to be able to answer for them.

Got a graphic up now with that number.

Yes.

And from that, they will also be referred to someone like Dr. Lucky's office with NAMI or another counseling service that can provide them individual counseling services or group counseling services in an outpatient setting.

Your council has been the organization is budgeted at about $200,000 a year.

What can you do?

What can you do with that?

Well, we had to get very creative with the budget that we have so far.

We are working on several initiatives to work with several different populations, whether it's the youth or college aged students.

There's also working and training other counselors to be able to take the calls and to handle the processing for counseling services, and then also to create that awareness and from advertisement for the public use so they can see that there's help available.

Warning signs.

Well, I mean, you know, the first is, you know, when you can't stay away, that's the first sign.

I mean, and then, you know, we have can't pay your bills.

Money's missing.

We can't explain where it's going.

You know, it's kind of like if you look at an addict, it's like alcohol or drug abuse.

You know, you get you got the same fines, you know, missing money, missing time, missing work, you know, And these are just kind of the same signs that we have over into to the gambling addiction, because this is an addiction.

I mean, it is it it's liquor, it's drugs.

It's yeah, it works in the same way.

Yeah.

The same parts of our brain that set off when you use drugs or alcohol is the same.

It makes you feel happy when you're doing these things.

It makes you feel happy when you're down at the casino and and you know, you're getting all the free stuff that they're giving away and chances to enter trucks and cars and I mean purses and jewelry and all kind of things.

And it and it's also I always say to our clients, so it's a sign for loss of time, a loss of time with family, a loss of time from work, from persons that I know, clients that we've had before.

They can stay 4 hours.

Right.

And whether it's on location at the actual facility, location, casino betting place, or it's just on their phone.

Got to end it there because we're out of time.

Dr. Lucky, Venus Snider, thanks so much for your your contributions.

Come back soon.

Thank you.

Thank you.

Thank you.

And good luck, as always.

Thank you for watching.

See you next week.

Support for Arkansas Week provided by the Arkansas Democrat-Gazette, The Arkansas Times and KUAR FM 89.