BEYOND THE NUMBERS
Not only have over 18,000 Arkansas Medicaid beneficiaries lost health coverage for not meeting a rigid work requirement since it took effect in June, but we also see no evidence for Governor Asa Hutchinson’s repeated claims of late that the work requirement has helped many beneficiaries find jobs.
Under Arkansas’s federal Medicaid waiver, certain Medicaid beneficiaries must report at least 80 hours of work or work-like activities each month or lose coverage after not complying for three months. So far, well over half of those subject to monthly reporting have lost coverage. Despite these massive disenrollments, Governor Hutchinson said in December, “we’re already seeing significant signs that the program is accomplishing its intent.” This month, he tweeted, “According to @ADWSInfo, over 6,200 AR Works participants have moved into work since the work requirement was implemented in June.”
The tweet refers to Arkansas’s Department of Workforce Services (ADWS), which estimated the number of beneficiaries who have found employment since the work requirement began by using figures from the state’s New Hire registry.
But the state has provided no evidence that the work requirement caused these new hires. Low-income workers frequently begin new jobs or change jobs. To show that the work requirement caused these new hires, the state at least would have to compare these numbers to those from months before the work requirement took effect or to the same months in the prior year, which it hasn’t done.
In fact, other evidence indicates that at most a few hundred people may have found jobs due to the federal waiver. Most Medicaid beneficiaries don’t face monthly reporting requirements, mainly because they’re already working, were already subject to SNAP work requirements, or qualified for exemptions. Only the remaining group, which has to report hours each month, faces any new work incentive due to the new policy. And of that group, only a few hundred each month have met the requirement by reporting some work hours, the state reports. What’s more, many of them likely would have found jobs anyway.
These data are consistent with focus group interviews showing that the work requirement isn’t changing most beneficiaries’ behavior. Beneficiaries already had enough reasons to work: they need to pay their bills. But they often struggle with unstable work hours, live in rural areas with few jobs, or face other barriers to employment — and the state hasn’t invested any new money in job training programs, services to address barriers, or supports like transportation to help beneficiaries connect to jobs.
Meanwhile, the work requirement has even proved counterproductive for some. News reports describe working beneficiaries who struggled with the reporting requirement and lost coverage. Consequently, some of them have gone without needed medication, worsening their health and in some cases costing them their jobs.
The New Hires data to measure employment gains have other problems as well:
- Employers must report all new hires, even people who only work one day or a few hours.
- The data don’t capture wage or hour information, so they don’t show if the job is part-time or full-time or what the salary is.
- They don’t show if the job is temporary, such as seasonal work around the holidays.
- They don’t show if the new employee had been unemployed or just changed jobs.
Moreover, any small increase in employment must be viewed in light of the 18,000 beneficiaries who lost coverage. States can connect beneficiaries to job opportunities through a workforce promotion program, as Montana does, without ending coverage for those who can’t meet a rigid work and reporting requirement. That approach targets resources to the small number of beneficiaries who can work but aren’t doing so without eliminating coverage from beneficiaries who are working or qualify for exemptions, as Arkansas has done.
Unless Arkansas’s policy is really intended to end coverage for thousands of Arkansans, Governor Hutchinson’s statement that it’s “accomplishing its intent” is incorrect.