Magazine November 2018

Off the Rolls: Arkansas’ Medicaid Work Requirement


by Caleb Talley

Arkansas became the first and only state in the nation to incorporate a work requirement into its hybrid Medicaid-expansion program when Gov. Asa Hutchinson rolled out the policy this spring, standing alongside Seema Verma of the Centers for Medicare and Medicaid Services.

The revision to the Arkansas Works program, which was unveiled in 2017 and approved by the Trump administration in early 2018, requires able-bodied, non-exempt participants to spend 80 hours a month in a job, in school or volunteering to be eligible for partial or total government payment of their health care insurance premiums.

Enrollees are exempt from reporting so long as they are employed at least 80 hours a month, already meeting SNAP requirements, medically frail or disabled or have at least one dependent child in the home. If non-exempt enrollees do not comply and report their compliance over a nonconsecutive span of three months during a 12-month period, they will lose their health insurance coverage.

Arkansas Works enrollees who fall into this population must report their work, school or volunteer hours through an online portal that, in April, Hutchinson said was a simple way to know who was qualified to receive benefits. What framers of the policy did not realize, however, was how few enrollees had ready access to the internet and how difficult they would be to reach to notify them of the process.

According to a study conducted in May by the Urban Institute, a nonprofit research organization, an estimated 22,000 Arkansans (8 percent of the state’s Medicaid program) would be subject to the requirement. In June, as the provision was put into place, the Department of Human Services estimated that about 69,000 people would eventually be required to report their work activity hours.

That figure continues to climb.

Nearly 26,000 were subject to the state’s new requirement as of June 30, according to the Arkansas Department of Human Services. That figure grew to more than 43,000 as of July 1. By August, it had reached over 60,000. By October, 76,222 Arkansans were estimated to be subject to work requirements in September. That number will continue to grow as more enrollees are phased in.

The program met its first three months of work requirements in August. More than 4,350 Arkansans were considered non-compliant, becoming the first to lose their health care insurance.

“4,353 is certainly higher than we would like,” Hutchinson said at a Sept. news conference. “The goal of Arkansas Works is to bring able-bodied people receiving health insurance benefits into the workforce.”

The governor also said that approximately 1,000 Arkansans found work as a result of the program.

“Whenever you stop thrashing around about how evil this is, look at whether or not we’re achieving our objective,” Hutchinson says. “There are people that have either gotten a better paying job or are in work or training. They would not have been in there without this impetus to say you can do better in life, and we want to help you to do better. That’s how I measure it. I think there is success thus far, and I think that there will be more success in the future.”

On Oct. 15, DHS announced that another 4,109 Medicaid recipients had been removed from the rolls as a result of noncompliance or failure to report. In total, approximately 8,500 Arkansans have had their health insurance terminated since the program went into effect. They are now barred from the program until Jan. 1.

At the beginning of the new year, Arkansas Works recipients ages 19-29 will be phased into the work requirement program.

For many Medicaid enrollees who fall into the work requirement category, understanding the reporting process has been an issue. Insurers and health care providers have been working to reach and help those who need to report their work activity, volunteer hours or exemptions.

“Our role, primarily, has been to work with the state and other stakeholders to make sure individuals who are in this first wave are aware [of] this requirement,” says Maxine Greenwood, director of government and media relations at Arkansas Blue Cross Blue Shield (BCBS). “We offer as much assistance as we can to help them navigate the process of creating an account or linking to an existing account, reporting their hours.”

Greenwood says for most Arkansans now classified as non-compliant, the biggest challenge is learning what is required of them. A large number who are required to report are unaware they are considered non-compliant. And insurers are struggling to reach them.

“I think it’s fair to say the biggest challenge is just getting the information to make contact with them,” says Greenwood. According to her, contact information received by insurers is taken at the time of enrollment, which was done by DHS. Addresses for many may now be out of date. Phone numbers may not be up to date, either.

Insurers are also working with health care providers to help communicate with Medicaid enrollees. “It’s important that we work mostly with the provider community – the doctors, the hospitals, the pharmacy,” Greenwood says. By engaging the provider community, she says, insurers aim to reach those who are falling through the cracks.

Arkansas Advocates for Children and Families and other groups opposed to the Medicaid changes, as well as Democratic candidates for state offices, have argued that the online verification portal could be a significant stumbling block for Arkansans with limited internet access. According to U.S. News & World Report, Arkansas ranks among the worst in the nation in internet access.

In response to this issue, insurers are working to bridge the gap for those who need help to report. The state approved the use of registered reporters, representatives tasked with helping enrollees log their hours or exemptions. Enrollees who fall into this population can call and give their hours or exemptions to registered reporters, who can enter that information into the portal for them.

As of Oct. 1, 258,519 people were enrolled in Arkansas Works, down from 285,564 in January, according to the state Department of Human Services. In addition to the 4,109 who lost coverage at the end of September, another 4,841 are just one strike away from being next. Another 7,748 Arkansans are two strikes away.

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