As of late May, some groups said they still hadn't received guidance from the state about which Medicaid enrollees are affected and what their organizations' responsibilities are. The Arkansas Hospital Association offered its first webinar update to its members on May 29.
"I understand that the system is trying to get people back to work," said Steve Henson, CEO of the Bradley County Medical Center, a critical access hospital in southeastern Arkansas, where the median household income is $34,665. "But to find a meaningful job in our part of the state can be a real challenge."
By July 5, 27,140 low-income adults ages 30 to 49 participating Arkansas' Medicaid expansion program must either report that they completed 80 hours of work or community engagement activities during the June 1 to July 5 reporting period, or that they qualify for an exemption. All reporting must be done through the state Department of Human Services' online portal, with no option to report in person or by phone or mail.
By Sept. 5, the number who must report will total 93,471, according to the state Department of Human Services. Starting in 2019, all Medicaid expansion beneficiaries from ages 19-49 will have to report, with most having to do so each month.
People who fail to meet the community engagement or reporting requirements for three months in a row can lose Medicaid coverage for the remainder of the calendar year. That means some Arkansans could start losing their benefits in September.
There is no official estimate of how many Arkansans will drop out of Medicaid as a result of the work requirement.
Kentucky's work requirement, which has been challenged in federal court in Washington, takes effect July 1. The outcome of that lawsuit could affect the work requirements in Arkansas as well as Indiana and New Hampshire.
Arkansas' Republican-controlled Legislature had pressed for the work requirement as a condition for approving continued funding for the state's Medicaid expansion program, which had helped cut the state's uninsured rate in half. The waiver, approved by the CMS in March, requires non-disabled Medicaid expansion enrollees to work, go to school, get job training or participate in volunteer community service to keep their coverage. There are exemptions for people who are medically frail, have dependent children, are receiving substance abuse treatment, or who are caregivers for disabled people.
"This is not about punishing anyone," Republican Gov. Asa Hutchinson said when the waiver was approved. "It's to help them move out of poverty and up the economic ladder."
Arkansas officials say they're doing everything they can to help people keep their coverage while meeting the new requirements.
"We understand the importance of individuals' healthcare, we don't take it lightly," said Marci Manley, a spokeswoman for the Arkansas Department of Human Services. "We have a strategic plan for making sure we've provided information and support, and we've focused on it heavily."
Her agency has identified public internet access sites where people can go online and report, or they can authorize an insurance broker or healthcare provider to enter the information for them, Manley said. DHS is working with the Arkansas Foundation for Medical Care, healthcare providers, health plans and the state Department of Workforce Services to contact enrollees and help them report and meet the requirements, Manley added.
Arkansas Blue Cross and Blue Shield, one of the three insurers participating in the state's privatized Medicaid expansion program called Arkansas Works, said it's been working with DHS for months to prepare for the new work requirement. The first round of reporting in June will affect 4,800 of its members.
Max Greenwood, director of government affairs for Arkansas Blue Cross and Blue Shield, said her plan is collaborating with insurance brokers and pharmacists to contact members and make sure they understand what they need to do to keep their coverage. She acknowledged it will be challenging to reach members who are transient or who lack cell phones.
Other observers worry that Arkansas is allocating only about $1.1 million in new funding for administering the work requirement program. DHS will refer beneficiaries who need employment and training assistance to the state Department of Workforce Services, which serves beneficiaries of the Supplemental Nutrition Program and the Temporary Assistance for Needy Families program who already must meet work requirements.
That lack of significant new resources is in sharp contrast to other states gearing up to administer Medicaid work requirements. Kentucky, for example, plans to spend nearly $190 million over the next two years to implement its waiver.
"It's very unrealistic for the state to think they'll be able to successfully roll out and monitor this program and provide support to a large number of people without any additional investment or capacity," Little said.
Gracie Gonner, executive director of the Family Center Inc., a social services agency in Helena, said there are employment, educational, and volunteer opportunities in her community that would enable Medicaid enrollees to meet the new requirements.
But she said additional resources will be needed to help people maintain participation in those activities, such as employment coaches and mental health counseling. She's seen the problems TANF and SNP beneficiaries have had in sustaining their participation in jobs and volunteer positions.
Henson, at the 33-bed Bradley County Medical Center, said Medicaid expansion beneficiaries account for 10% of his hospital's patients and 14% of its emergency department visits. He is nervous about people losing coverage due to the work requirement in an area where it's hard to find a decent job and many low-income residents don't have a car.
"It could have a real impact on us if these folks lose coverage," he said. "The margins for critical access hospitals range from break even to 3-4%. If we have more uninsured, that can make a real difference."
Correction: The original article inaccurately said beneficiaries' first monthly reports were due June 5.