Director of Medicaid Eligibility and Enrollment
Arkansas imposed its Medicaid work requirement on 40,000 more beneficiaries in January as it began adding 19- to 29-year-olds to those who must report at least 80 hours per month of work or work-like activities; until now, it applied only to those aged 30-49. That means that more than 105,000 Medicaid beneficiaries can now lose their health coverage if they don’t qualify for an exemption or can’t meet the reporting requirement in any three months of the year.
Over 18,000 beneficiaries lost Medicaid coverage last year due to the requirement, and the share of beneficiaries satisfying the reporting requirement in January remained low, so many more beneficiaries will likely lose coverage in 2019.
In Arkansas, beneficiaries lose coverage if they don’t comply for three months in a year. The three-month “clock” reset in January, so no beneficiaries lost coverage for not reporting in January. But the state’s January data show continued high rates of non-compliance among those required to report. The state exempted almost 90 percent of the 105,000 beneficiaries subject to the work requirement, leaving just under 12,000 who had to report. Of those required to report work activities, about 87 percent failed to report or failed to report enough hours to meet the requirement. Almost 9,000 beneficiaries now have one month of non-compliance in 2019 and, with two more this year, will lose coverage.
The low reporting numbers in January suggest that 19- to 29-year-olds are struggling with the same issues the older group has faced: lack of awareness that they are subject to a work requirement, difficulty reporting their compliance, and trouble understanding the complex rules around exemptions and allowable work activities.
Moreover, the state keeps expanding the population subject to the work requirement despite lacking an approved research and evaluation plan. If the waiver doesn’t give beneficiaries incentives to participate or improve health outcomes, the Centers for Medicare and Medicaid Services (CMS) can end it. But CMS hasn’t even begun to evaluate the waiver’s effectiveness, though Arkansas’ work requirement has been in place for over eight months and has taken coverage away from thousands.
Individuals who lost coverage last year could have re-enrolled effective January 1, but only about 1,400 of the 18,000 who lost coverage have done so. Most of those who lost coverage — many of whom did not even know they were subject to the work requirement — are likely unaware that they are again eligible or may struggle to navigate the application and verification process. Or, knowing that the state will likely end their coverage again after three months of non-compliance with the requirement, some residents may be waiting to enroll until a later time when they may need coverage more.
Arkansas’ experience continues to serve as a warning to other states about the consequences of taking coverage away from people who can’t meet rigid work requirements. As more states consider or begin to implement Medicaid work requirements, they should look to Arkansas and see that work requirements don’t work.