4,100 more Arkansans lose Medicaid over work requirements

More than 4,100 Medicaid expansion enrollees in Arkansas will lose coverage for the rest of 2018 because they did not comply with the state's work requirement policy, state officials announced Monday.

That's on top of the 4,353 people who were dropped from Medicaid rolls last month.

In all, 76,200 Arkansans ages 30 to 49 were subject to the requirement and must spend 80 hours per month working, volunteering, going to school or receiving job training. Most either met the requirement or qualified for exemptions. Next year, individuals ages 19 to 29 will be subject to the mandate.

In total, 15,276 adults were terminated this month from the state's Medicaid expansion program due to factors including noncompliance with the work or reporting rules, inability to contact the person or increased household income. Non-compliance and failure to return requested information accounted for more than half the terminations.

More than 4,800 additional Arkansans are at risk of losing Medicaid coverage next month because they haven't complied with the work requirement for two months.

Only 1,532 people who were not exempt from the work requirement reported meeting the 80-hour requirement in September.

Arkansas Republican Gov. Asa Hutchinson said last month that the program's goal is to boost labor participation and increase work training and assistance to able-bodied people who want to work. He cited state data showing that about 1,000 people gained job training or employment as a result of the program.

But the new coverage loss figures heightened concerns among healthcare providers and advocacy groups about the viability of the complex work and reporting requirements. They fear the new system will disrupt care for people with chronic conditions and drive up uncompensated care costs. The Arkansas Hospital Association has said it would like to see the requirement halted.

"I hope they are rethinking this," said Marquita Little, health policy director at Arkansas Advocates for Children and Families. "The best course forward is to halt continued implementation and have a conversation about whether this is right policy."

Meanwhile, U.S. District Judge James Boasberg in Washington is hearing a lawsuit challenging the CMS' approval of the Arkansas Medicaid waiver permitting the so-called community engagement requirement.

In June, Boasberg invalidated the CMS' approval of a similar requirement waiver in Kentucky on the grounds that the agency did not adequately consider its impact on coverage. Following that ruling, the CMS held a new public comment period on the Kentucky waiver and is expected to re-approve it in some form.

Two other Republican-led states, Indiana and New Hampshire, also received CMS approval earlier this year for a five-year demonstration waiver to establish a community engagement requirement. Their programs haven't started yet.

Ten other states have requests pending to establish similar Section 1115 demonstrations. The Trump administration in January encouraged states to seek work requirement waivers.

In Arkansas, beneficiaries must report that they were either meeting the community engagement requirement or that they qualified for an exemption, such as for a disability. They can only report through an online portal run by the state Department of Human Services. There is no option for reporting by phone, mail or in person.

Many beneficiaries have not been contacted about the new work and reporting requirements and either aren't aware or don't understand them, according to report issued last week by the Kaiser Family Foundation.

Enrollees may be hard to reach by phone due to unstable housing or other factors, and a large percentage lack email or internet access, the report found. In addition, the online reporting process is complicated and confusing, even to advocates and providers that have tried to help beneficiaries.

Hutchinson last month stressed that the state is providing substantial assistance, including in-person assistance in county offices, to anyone who has limited internet access or who encounters other reporting challenges. He sidestepped the question of whether the state is reconsidering its sole reliance on the online reporting system.

At the current rate of people being dropped, the total number of Arkansans losing coverage could be as high as 36,000 in 2018, growing to about 50,000 in 2019, according to a recent Health Affairs article.

Nearly 260,000 people are enrolled in Arkansas' Medicaid expansion program, called Arkansas Works, which has helped cut the state's uninsured rate nearly in half.

With more Arkansans losing Medicaid over the coming months, "it won't be long before hospitals, clinics and primary-care doctors begin to feel the effects," Little said. "What will this mean in three months when that number has tripled?"