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Advocates Lambast Growing Number of Uninsured in Arkansas Due to Work Rules

Allison Inserro
As Arkansas said this week it removed thousands of people from its Medicaid expansion program for not reporting work requirements, advocates for those with low incomes said those subject to the rules are probably unaware of them. 
Arkansas said this week it removed more than 12,000 people from its Medicaid expansion program over the past 3 months for not complying with work and community engagement requirements, and another 6000 are at risk of losing their health coverage by December. On Friday, the executive director of the Center for Children and Families at the McCourt School of Public Policy at Georgetown University called those numbers “chilling.”

Joan Alker, who is also a research professor at the university, said the numbers show “our worst fears are being realized.”

The state said more than 3800 people lost their Medicaid coverage for not complying in October with the rule, which requires them to work 80 hours a month. Beneficiaries lose coverage if they don’t meet the requirement 3 months in a calendar year, and they cannot re-enroll until January. Nearly 8500 people had lost coverage over the previous 2 months.

Another 6000 people will lose health coverage if they don’t meet the work requirement November 30.

Arkansas was the first state to enforce the requirement after the Trump administration allowed states to tie health coverage through Medicaid to work. Kentucky was the first state to win approval for a work requirement, but a federal judge blocked the state from enforcing it. The Arkansas requirement is being challenged as well in the same federal court.

Under the Trump administration, CMS is portraying Medicaid as a program that serves “able-bodied” adults and is promoting work requirements as a way to gain self-sufficiency and even better health. Health policy research, however, has not yet borne that philosophy out, finding many complicating factors in trying to understand the nuances between poor health, unemployment or low unemployment, education, and more.  

Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) asked HHS to hit pause on the program, noting that the state has no evaluation plan in place to see if it is working. MACPAC said that the current process is likely not structured in a way that provides enrollees an opportunity to succeed under the requirements.

On her blog Friday, Alker posted, “Many of these folks are probably unaware of the fact that they have lost coverage and will only learn that they are uninsured when they next need to fill a prescription or show up at a doctor’s office or clinic for care.”

“Of the approximately 69,000 folks affected by the reporting rules, more than 3/4ths (just shy of 54,000) are being exempted by the state’s computer system without any action by the beneficiary,” Alker wrote. Many are already exempt; of those who are not, the majority (more than 12,000) have not satisfied the reporting requirement, she said.

Many of those losing coverage are likely disabled and should be protected by the Americans with Disabilities Act (ADA), the Center on Budget and Policy Priorities (CBPP) said this week, noting “that more Arkansans are losing Medicaid coverage than the presumed target group of people who are not working and do not qualify for an exemption.”

The CMS waivers allowing Medicaid work requirements in Arkansas, Kentucky, Indiana, New Hampshire, and Wisconsin acknowledge the role the ADA has in protecting Medicaid beneficiaries with disabilities, but the actual execution of that protection is flawed, the CBPP said. It is also at odds with “Medicaid’s objective of providing affordable coverage to people who wouldn’t otherwise have it,” the center said.

In January, the Arkansas requirement will expand to include those aged 19 to 29 years. The requirement is being enforced on participants aged 30 to 49 this year.

At a press conference in September, Republican Governor Asa Hutchinson and his staffers would not give projections about how many state residents are likely to become uninsured as a result of the work requirement.

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