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If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. Those who don't may have to pay more of the cost of their medical services, and in some cases may be refused services.

Supporters say it will help nudge Medicaid beneficiaries toward becoming more cost-conscious health care consumers. Patient advocates are skeptical, pointing to studies showing that such financial "skin-in-the-game" requirements discourage low-income people from getting care that they need.

The states of Michigan and Indiana have already implemented health savings accounts for their Medicaid programs, modeled after the accounts that are increasingly popular in the private market.

In Michigan and Indiana, people can use the funds, which may be supplemented by the state, to pay for services subject to the plan deductible, for example, or to cover the cost of other medical services.

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