As Predicted, Arkansas’ Medicaid Waiver Is Taking Coverage Away From Eligible People
Six months into
Since June,
As of
The harm to beneficiaries will likely continue to grow next year, as
Among those subject to the work requirement, 13 percent failed to meet them for November. (See Figure 1.) The main reason even more Arkansans haven't lost coverage seems to be that most beneficiaries didn't have to report any new information to comply with the work requirement: state data already showed they were working or qualified for exemptions. Among those who needed to report, few succeeded -- around 80 percent of those who had to report exemptions or work hours failed to do so last month.
See chart here (https://www.cbpp.org/health/commentary-as-predicted-arkansas-medicaid-waiver-is-taking-coverage-away-from-eligible-people).
The number losing coverage exceeds the supposed target population: beneficiaries not working and not eligible for exemptions. Studies estimate that around 4 percent of those subject to the work requirement are not working and do not qualify for exemptions.(3) Yet each month, 13 to 29 percent of those subject to the requirement have failed to report sufficient hours, many of them not reporting any hours.
News accounts corroborate that eligible people are losing coverage.(4) For example, one working beneficiary with a chronic condition described losing his Medicaid coverage and then being unable to afford medications, in turn losing his job due to his deteriorating health. Another is rationing her medication after being unable to navigate the reporting requirement and losing coverage, despite working 25 to 35 hours each week -- which equates to well over the monthly minimum.
But while
* Complex rules creating significant confusion among beneficiaries. Some beneficiaries apparently believed they could maintain their coverage by reporting work hours just once, not realizing they needed to report every month. Also, clients can only count up to 40 hours of job search each month, but several beneficiaries reported over 80 hours of job search for November. These beneficiaries likely thought they were complying as they diligently looked for work and reported their hours but were not actually within the confines of the rigid policy.
* Lack of staff support. The state hasn't hired additional staff to answer questions or make accommodations for individuals with disabilities. Arkansas Human Services Director
* Insufficient and ineffective outreach. Some beneficiaries never learned about the new rules in the first place. The state conducted much of its outreach through social media and online videos that failed to reach much of the population without access to computers or the internet. And although the state along with health plans, providers, and advocates conducted outreach to educate beneficiaries about the new work requirement, they failed to reach many enrollees due to inaccurate phone numbers in case files.(8)
The data so far appear inconsistent with any meaningful gains in employment as a result of the policy. While many beneficiaries have met the requirement by working, nearly all of those were people who were automatically deemed compliant because they were already working before the new rules took effect or because they complied with work requirements under SNAP (formerly food stamps), which were also already in place. Only 371 beneficiaries met the requirement by reporting work hours for November. Since at least some of those people would likely have found work anyway, this is likely an upper bound on the policy's effect on employment, and it amounts to about 0.5 percent of beneficiaries subject to work requirements.
That outcome is no surprise in light of evidence that work requirements in other federal programs have had limited effects on employment, and given
Footnotes:
(1)
(2) For data availability reasons, we calculate coverage loss as the total cases terminated as of December (16,932) as a portion of the cases subject to the work requirement in September (after all four groups were phased in) plus the number of cases terminated effective
(3)
(4) "With new work requirement, thousands lose Medicaid coverage in
(5)
(6)
(7)
(8)
(9) "Taking Away Medicaid for Not Meeting Work Requirements Harms People with Disabilities," Center on Budget and Policy Priorities, updated
(10)
(11)
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