Arkansas' Medicaid work requirement for people age 30-49 did not increase employment, according to a Health Affairs study released Tuesday.
Researchers also found that most of the 2018 Medicaid coverage losses—about 18,000 people lost coverage after the work requirement went into effect—were reversed after a federal judge shutdown the state's work requirement in April 2019.
Half of people in Arkansas aged 30-49 who lost Medicaid coverage reported serious problems paying medical debt or delaying care because they couldn't afford it. Nearly two-thirds said they delayed taking medications because of cost.
"These rates were all significantly higher than among Arkansans who had maintained their Medicaid or marketplace coverage all year," according to the study. "This is consistent with prior evidence on the harmful effects of churning in coverage."
The Trump administration and several Republican-led states support policies that make Medicaid coverage conditional on work and other activities. Proponents of such policies say they will lower excess government spending and improve health by encouraging people to work. But critics say work requirements will lead to unnecessary and harmful coverage gaps without boosting employment. CMS has allowed 10 states to move forward with Medicaid work requirements as of July, but Arkansas' policy is the only one to have gone into effect, as many plans are still in the works or blocked by the courts.
More than 70% of all Arkansas residents were unsure whether the policy was in effect, and less than 6% knew it wasn't in effect as of late 2019. The researchers said misinformation and confusion are major barriers to carrying out work requirements.
Arkansas also made key mistakes when it rolled out its work requirement in 2018. The study's authors found nearly 90% of people that responded to the survey "would have preferred a method of reporting work activities to the state other than a computer web-based system, which was Arkansas's exclusive approach for the first several months of the policy."
"More than 95% of Arkansas beneficiaries in our survey already met the state's Medicaid work requirements or should have been eligible for an exemption. This suggests that barriers to reporting data to the state, rather than not meeting the requirements themselves, were the main cause for coverage losses in 2018," according to the study.
It cost more than $26 million to implement Arkansas' Medicaid work requirement. The state paid 17% of the administrative costs, while the federal government paid 83%.
The study's authors concluded their "results should provide a strong note of caution for federal and state policymakers considering work requirement policies in the future."