Sanders' announces plans for another work requirement for Medicaid recepients

Gov. Sarah Sanders announced on Tuesday plans to submit a waiver request to the federal government to add a work requirement to ARHome, the state's unique version of Medicaid expansion where Medicaid dollars pay for private health insurance for able-bodied adults with incomes up to 138% of the federal poverty level.

In 2018, during the Trump administration, Arkansas was the first state in the country to implement a work-reporting requirement for Medicaid beneficiaries. But a federal judge put a halt to the program in 2019, and after President Biden took office, his administration told states it wouldn't grant work requirement waivers anymore.

Sanders' new plan is decidedly different than the old work requirement. It would require the nearly 300,000 Arkansans who receive Medicaid to either work, go to school or volunteer in their communities. If they don't meet the criteria, rather than get booted off Medicaid all together, they'd be moved from a private plan to traditional fee-for-service Medicaid.

I've got questions out to health policy wonks for reactions to this plan. Having a private plan is undoubtedly better than a traditional Medicaid plan for beneficiaries, but it's hard to imagine this carrot-and-stick approach getting through to them. Health insurance is a byzantine world. I suspect most people don't understand all the advantages or disadvantages of their health care plan. I bet most ARHome beneficiaries don't know whether they're on a private plan or traditional Medicaid.

The state flirted with a similar approach when it sought a waiver for ARHome, but ultimately didn't propose what it framed as a work "incentive" in its waiver request.

Sanders said she felt confident the waiver would be approved, and used the occasion to demagogue on "the welfare state."

"When able-bodied Arkansans don't work, go to school or volunteer, they aren't just a burden on the taxpayer, they're also being denied a chance to achieve indepence from the welfare system," she said.

DHS Secretary Kristi Putnam said the plan was to submit the waiver by June 1 and propose Jan. 1, 2024, as the date the new requirement would go into effect.

UPDATE: Here's a statement from Bo Ryall, president and CEO of the Arkansas Hospital Association:

The Arkansas Hospital Association and its members have seen firsthand how important Medicaid expansion has been to both the people and the economy of Arkansas. We appreciate the proposed "safety net" of providing fee-for-service Medicaid to ARHOME participants not meeting work or community engagement requirements.

As hospital finances remain in critical condition because supply and personnel costs have escalated without an appropriate increase in reimbursement, we are concerned about the lower reimbursement that hospitals might receive for fee-for-service participants. We are hopeful that continued collaboration with Governor Sanders' team at the Department of Human Services will result in Arkansas patients having the greatest access to high quality hospital care.

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