Early data from Arkansas' Medicaid work requirement program showed multiple problems, including lack of awareness and hurdles to compliance, according to a new Kaiser Family Foundation report.
Despite what the report termed a "robust" multi-pronged outreach campaign, many enrollees haven't been successfully contacted. Additionally, the burden involved has the potential to prevent citizens, especially those with low English or computer literacy, from reporting. Coverage losses could result in care gaps, along with higher rates of uninsured and higher uncompensated care costs in Arkansas.
As of Sept. 9, more than 4,500 low-income people have lost Medicaid coverage because of the state's work requirement. Another 5,000 are at risk of losing their insurance with another month of non-compliance.
Arkansas was the first state to use a demonstration waiver to link Medicaid eligibility to meeting work or so-called community engagement requirements. CMS approved the state's Section 1115 waiver request March 5 and it took effect June 1.
So far, CMS has granted four states waivers to impose work requirements as a condition for assistance: Arkansas, Indiana, New Hampshire and Kentucky. At least nine other state applications are pending. Three Arkansas Medicaid enrollees have filed a federal lawsuit challenging the waiver amendment. And a federal judge struck down Kentucky’s work requirements in late June.
As such, eyes are closely watching the Arkansas results — especially since 4,574 people were found to be out of compliance for three months in early September and booted off their insurance.
Many Arkansas enrollees likely have little to no knowledge about the stipulations, according to the KFF report. Accurate phone numbers aren't always available for outreach, and when found many people still can't be reached.
Of the roughly 60,000 people subject to the rules, 27% didn't report the mandatory 80 hours of qualifying work activities per month at all, KFF said.
Online campaigns such as email, social media or video have a severely limited reach among enrollees without computer or internet access (especially in broadband deserts such as Arkansas' rural areas, where 30% of the state population is underserved).
For those aware of the requirements, adhering to them is difficult. For example, setting up an online account is a 14-step process involving security measures and linking outside coverage accounts.
And although the state's use of data matching has successfully exempted about two-thirds of enrollees, for non-exempt Medicaid beneficiaries reporting has the potential to be baffling.
Reporting rules are varied and complex. Students, for example, report weekly, not monthly. Reporting requires multiple steps and can only be done online. Some qualifying activities have different conversions to countable hours. Enrollees may be unaware they may have to prove their exemption status again in the future.
The report warns that some enrollees who are exempt may fall through the cracks, and those that aren't will face barriers to finding and keeping meaningful work (lack of transportation, low education, lack of job options, lack of federal funding for work supports and more).
CMS made work requirements a priority earlier this year, on the notion they can increase employment and earned income for Medicaid beneficiaries.
Yet the new KFF study supports data that most Medicaid recipients who can work already are, and instituting and tracking work requirements will add administrative burden onto an already-stressed chassis.
Those deemed out of compliance for three months will not be allowed to re-enroll for Medicaid until 2019 unless they apply for, and receive, a good cause exemption or become eligible for Medicaid through a different pathway.
Indiana and New Hampshire penalize non-exempt enrollees who don't meet requirements with suspension. Arkansas is the only state with complete insurance termination.