Arkansas Becomes Third State with Medicaid Work Requirement

Questions still linger regarding specifics of implementation.

By Mark Spivey

Arkansas has become the nation’s third state to implement a work requirement for Medicaid, according to an announcement made earlier this week by Governor Asa Hutchinson and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.

The state expects to notify applicable Medicaid recipients during the first week of April and require a select group to report on their work, education, and training activities by the start of June, according to a report published in Healthcare Dive.

The report noted that Arkansas has not yet won approval for a part of the proposal that would change the income requirement for Medicaid to 100 percent of the federal poverty level (instead of 138 percent).

“The Arkansas Department of Human Services estimated the work requirement and its planned income requirement would save the state $356 million in the next fiscal year. Most of that amount ($307 million) would come from the income requirement change,” Healthcare Dive’s report read. “Implementing both waivers would also result in nearly 63,000 people losing Medicaid coverage out of the more than 285,000 who currently get insurance through Medicaid in the state.”

Kentucky and Indiana are the two other Republican-led states that have introduced plans for a Medicaid work requirement, although Arkansas reportedly wants to be the first to actually implement one. In making the announcement, Verma reportedly said there are also eight other states with Medicaid work requirement waiver requests, with still others that have shown interest.

“In announcing the Arkansas work requirement waiver at the State House in Little Rock on Monday, Hutchinson said the state and CMS decided to move forward with launching the work requirement and not wait until they iron out the income eligibility piece,” Healthcare Dive’s report read. “The governor said the work requirement isn’t about ‘punishing anyone,’ but instead giving ‘people an opportunity to work.’ Hutchinson said the work requirement includes training and education programs to help people get out of poverty and jobs.”  

Verma reportedly described CMS as a “willing partner” with states showing similar proclivities.

The work requirement ultimately is said to be poised to affect Arkansas Works enrollees (those who receive coverage through Medicaid expansion) between 19 and 49 years old, with the Natural State easing in the requirement for 30-to-49-year-olds between June and September. Recipients will need to report 80 hours of work every month, to include job training, job searching, school, health education classes, or volunteering; those who don’t meet the requirement for any three months in a calendar year will reportedly lose coverage.

The plan has been met with fierce opposition in a nation with wealth inequality that has worsened dramatically during recent decades while working-class wages have stagnated.

“Critics say work requirements will only serve to make access to care more difficult for those who need it most. The majority of Medicaid beneficiaries are already from working families, but the requirement’s bureaucratic hurdles and paperwork needs could leave out those who should qualify,” Healthcare Dive noted.

“The harsh work requirement in Medicaid will likely set back the state’s considerable progress under the (Patient Protection) and Affordable Care Act (PPACA) in increasing coverage and improving access to care, health, and financial stability for low-income Arkansans,” Center on Budget and Policy Priorities Vice President Judith Solomon noted in a blog post.

Last year, Arkansas implemented a “work referral” process for Arkansas Works and has tracked how people referred to job searches and training have been progressing.

“The results of the referral showed that individuals who take advantage of these services are more likely to find a job than those who do not. Shifting from a voluntary ‘referral’ to a mandatory requirement that individuals work in order to receive their health insurance is expected to increase the number of enrollees who take advantage of state programs to assist in developing skills and obtaining jobs,” Hutchinson’s office said in a press release.