BEYOND THE NUMBERS
A large majority of the more than 18,000 Arkansas Medicaid beneficiaries who lost their Medicaid coverage since the state began implementing a first-in-the-nation Medicaid work requirement in June not only haven’t found jobs, but they also probably don’t have health insurance, new state data suggest.
Those who lost their Medicaid last year could have re-enrolled effective January 1, but only about 2,000 have done so. Some federal and state officials have argued that such low re-enrollment means that most who lost Medicaid have found jobs with health coverage, but there are no data to support the claim.
Asked what happened to the 18,000 Arkansans who lost coverage due to the work requirement, Health and Human Services (HHS) Secretary Alex Azar told a House hearing last Tuesday that “we do not yet have data as to why they fell off the program.” At the Senate Finance Committee two days later, Azar pointed to the low share of people who lost coverage last year and re-enrolled in January and said, “That seems a fairly strong indication that the individuals who left the program were doing so because they got a job.”
But state data released on Friday show that very few beneficiaries who lost coverage found jobs. Of the 18,164 beneficiaries who lost coverage in 2018 for not complying with the work requirement, 1,981 had matches in the state’s New Hire Database, indicating they found new work. That means that for the more than 16,000 others who lost coverage, there is no evidence that they found new work.
Moreover, these data almost certainly overstate the number of those losing Medicaid who found steady employment. That’s because:
- The New Hire Database includes individuals who were employed for only hours or days.
- The Database doesn’t capture wage or hour information, so it doesn’t show if the new jobs are full or part time or if they’re seasonal or permanent.
- The Database doesn’t show if the new employee was previously unemployed or just changed jobs.
What’s more, even many of those who found jobs are still uninsured. The New Hire Database doesn’t indicate if the new job provides health insurance, and only a minority of low-wage jobs do.
These data also don’t shed light on whether Arkansas’ work requirement is causing anyone to find new employment, as proponents of the work requirement suggested that it would do. Other evidence, in fact, suggests just the opposite. With or without this policy, Medicaid beneficiaries move in and out of jobs frequently, and the state offered no evidence that more beneficiaries are finding jobs than in prior years. Meanwhile, the 1,981 figure includes anyone with a match in the New Hires Database between June and January — so it includes people who got a job before enrolling in Medicaid, before they were subject to the work requirement, or after they were kicked off the rolls.
Moreover, as we have pointed out, the low re-enrollment rates are another sign of the problems with the policy, not its success. If beneficiaries don’t meet the reporting requirement for three months in a calendar year, they are locked out of Medicaid for the rest of the year but are eligible to re-enroll the following year. Most of those who lost coverage in 2018 — many of whom did not even know they were subject to the work requirement — are likely unaware that they are eligible to re-enroll this year 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.
As HHS admits, we don’t have sufficient data on what happened to the individuals who lost coverage. But the data that the state has released so far are consistent with our conclusion, based on other evidence, that the overwhelming majority of those losing coverage will become uninsured.