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What Do Arkansas Medicaid Work Requirements Say About Future Coverage?

Allison Inserro
In a test of what could happen as more work requirements are attached as conditions to receiving government health benefits or other forms of government assistance, more than 25% of Medicaid recipients in Arkansas are at risk of losing health insurance for failing to meet work requirements, a recent blog post in Health Affairs said. 
In a test of what could happen as more work requirements are attached as conditions to receiving government health benefits or other forms of government assistance, more than 25% of Medicaid recipients in Arkansas are at risk of losing health insurance for failing to meet work requirements, a recent blog post in Health Affairs said. The news comes as the Trump administration tries to figure out how to implement work requirements as a condition for those receiving Medicaid benefits, in the wake of a federal judge's ruling that Kentucky cannot immediately implement its own proposal to implement work requirements.

In June, Judge James E. Boasberg of the Federal District Court in Washington stopped the Kentucky plan after finding that HHS had failed to consider the state’s estimate that the new rules would cause low-income people to lose Medicaid coverage. He ruled that CMS' approval of the plan had been “arbitrary and capricious” because it had not adequately considered whether the plan would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

The Arkansas requirements took effect in June, and of the 25,815 Medicaid adults who were required to meet, or be designated exempt from the work requirement in June, the state reported that 7464 people—29% of the targeted population—did not meet the requirements.

The 25,815 individuals belong to the Medicaid expansion pool, beneficiaries aged 30 to 49, including those who received exemptions from the requirement. While these roughly 7500 adults will not necessarily lose Medicaid coverage immediately, the information underscores the scope of potential coverage losses, Health Affairs said. 
Arkansas is gradually phasing in requirements over 4 months in 2018 for adults aged 30 to 49 and will include adults aged 19 to 29 next year.

The total group will expand to 171,000 in 2019 when requirements are fully phased in. If the initial data predict losses for this growing group of beneficiaries, the total population losing coverage could be as high as 36,000 this year, growing to around 50,000 next year, or about one-sixth of the total Medicaid expansion population in the state.

Boasberg’s decision about Kentucky does not affect Arkansas, nor New Hampshire or Indiana. But his decision highlights the need for “transparent reporting about potential caseload losses,” Health Affairs said.

Arkansas did provide detailed information about those who met, did not meet, or were exempted from work requirements during their first month in effect.

Of note, 40% of the 25,815 adults in the target population are required to use an online portal to report activities, and the Urban Institute has estimated that about one third of beneficiaries likely not exempt from work requirements do not have internet access at home. The Urban Institute has also estimated that another third who are already working, but not exempt, likely have inconsistent hours and will not be able to meet the work requirements throughout the year.

Using the mail or telephone to report activities are not allowed.

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