Governors stand by controversial Medicaid work rules

Republican governors defended their pursuit of applying work requirements to able-bodied Medicaid beneficiaries in the wake of thousands of people losing coverage.

Arkansas Gov. Asa Hutchinson, during an event on Friday sponsored by Politico, shot back at critics of the state's controversial work requirement program that has led to nearly 18,000 people in his state to lose Medicaid coverage. Hutchinson and other governors are in town for the winter meeting of the National Governor's Association.

Hutchinson said that there needs to be consequences for people who do not meet the requirements.

"If you don't have some consequences for irresponsible action then it is a meaningless program," Hutchinson said.

The program requires able-bodied Medicaid beneficiaries to complete 20 hours a week of either work, training or volunteering.

He added that some people have criticized the program because "some people don't like to have the requirement where you have to report that you are in compliance. If you don't comply you lose insurance till the end of the year."

However, critics have claimed that Arkansas has made it difficult for affected Medicaid beneficiaries to report to the state because they have to report online.

In an unusual move, the nonpartisan Medicaid and CHIP Payment Advisory Commission wrote to HHS Secretary Alex Azar in November 2018 about initial reports that more than 8,000 Arkansans were kicked off Medicaid because they didn't report per the work requirements.

"While states are typically required to provide beneficiaries with multiple means of submission, the only way beneficiaries in Arkansas may report compliance is through an online portal," the commission said. "This approach may be challenging for beneficiaries given limited Internet access in the state and the multi-stage process for establishing an account and entering information."

But Hutchinson said that now beneficiaries can report in person, online or by telephone.

"We are investing a lot in making sure that they do know and have the help that they need," he said. "I think it has helped us to make sure the system is a good use of taxpayer dollars."

Arkansas is one of seven states that got approval from the CMS to create a work requirements program.

The other states are Kentucky, New Hampshire, Wisconsin, Indiana, Arizona and Michigan, according to data from the Kaiser Family Foundation.

Except for Arkansas, Indiana is the only other state to have implemented the work rules.

Maine was granted a work rules waiver in 2018 but new Democratic Gov. Janet Mills pulled the state out of the waiver after succeeding Republican Paul LePage in January. Kentucky's program has been delayed due to a court challenge. A federal judge in Washington, D.C., blocked the program from going into effect and that same judge is hearing a challenge to Arkansas' program.

Indiana's work requirement program went into effect this January but people don't have to start reporting until July.

Republican New Hampshire Gov. Chris Sununu said that his state is trying to do a more gradual phase-in of the requirements.

"There are some states that were aggressive on it and rolled it out in a way that had legal challenges or regulatory hurdles to overcome," Sununu said at the Politico event. "We simply tried to learn from those mistakes."

New Hampshire's program, which is expected to be implemented this year, requires beneficiaries to work more than other states. Affected beneficiaries must complete 25 hours a week to remain compliant as opposed to 20 hours for Arkansas.

Beneficiaries who don't comply with the requirements will face suspension from Medicaid a month after failing to report.

Sununu said that the state is looking into a self-attestation period where "people basically self-report how their progress is going and we help keep them on track."

"You've got to give some flexibility to the system and when you do that amazing things happen," he said.