Arkansas gets Medicaid work requirement
Arkansas Gov. Asa Hutchinson and CMS Administrator Seema Verma announced Monday the state is the third to have a Medicaid waiver with a work requirement approved. Arkansas expects to notify applicable Medicaid recipients during the first week of April and require the first group to report their work, education and training activities by June 1.
The state has not, however, won approval yet for a part of the proposal that would change the income requirement for Medicaid to 100% of the federal poverty level instead of 138% of FPL.
The Arkansas Department of Human Services estimated the work requirement and its planned income requirement would save the state $356 million in the next fiscal year. Most of that amount ($307 million) would come from the income requirement change. Implementing both waivers would also result in nearly 63,000 people losing Medicaid coverage out of the more than 285,000 who currently get insurance through Medicaid in the state.
Arkansas is the latest Republican-led state to win a CMS waiver to beef up requirements for participation in Medicaid. Though Kentucky and Indiana already have work requirement waivers, Arkansas officials hope to become the first to implement the policy. Verma said there are also eight other states with Medicaid work requirement waiver requests and more have shown interest.
In announcing the Arkansas work requirement waiver at the State House in Little Rock on Monday, Hutchinson said the state and CMS decided to move forward with launching the work requirement and not wait until they iron out the income eligibility piece. The governor said the work requirement isn't about “punishing anyone,” but instead giving “people an opportunity to work.” Hutchinson said the work requirement includes training and education programs to help people get out of poverty and jobs.
Verma said her CMS is a “willing partner” with states and is trying to give them the flexibility to run the Medicaid program that works for them. She said it's easy to hand someone a health insurance card, but it’s much harder to get them off Medicaid to a “better life and job that offers them health insurance.”
The work requirement will affect Arkansas Works enrollees (those who receive coverage through Medicaid expansion) who are between 19 and 49 years old. The state will phase in the requirement for 30 to 49-year-olds between June and September.
Those able-bodied individuals will need to report 80 hours of work every month. That can include job training, job searching, school, health education classes or volunteering. Those who don’t meet the requirement for any three months in a calendar year will lose coverage.
Critics say work requirements will only serve to make access to care more difficult for those who need it most. The majority of Medicaid beneficiaries are already from working families, but the requirement's bureaucratic hurdles and paperwork needs could leave out those who should qualify.
As a result of its Medicaid expansion, Arkansas covered 330,000 newly eligible adults by the end of 2016. Those gains will almost certainly slide back down, according to Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. The "harsh work requirement in Medicaid will likely set back the state’s considerable progress under the Affordable Care Act (ACA) in increasing coverage and improving access to care, health, and financial stability for low-income Arkansans," she wrote in a blog post.
Last year, the state implemented a “work referral” process for Arkansas Works and has tracked how people referred to job search and training have been progressing.
“The results of the referral showed that individuals who take advantage of these services are more likely to find a job than those who do not. Shifting from a voluntary ‘referral’ to a mandatory requirement that individuals work in order to receive their health insurance is expected to increase the number of enrollees who take advantage of state programs to assist in developing skills and obtaining jobs,” Hutchinson’s office said in a press release.
While Arkansas got its work requirement waiver, the state doesn't have the OK to harden the income eligibility yet. Arkansas wants to change the Medicaid expansion income requirement from 138% of federal poverty level (FPL) to 100% of FPL. Hutchinson said the state and CMS will continue to work on that piece.
Republicans were not able to repeal the ACA on Capitol Hill last year, but the CMS’ waivers and Trump administration executive orders and policies are reshaping the health law.