Editor’s Note: This is the last in four-part series looking at Arkansas’ work requirements for Medicaid. The series began Thursday.
Gov. Asa Hutchinson’s new work requirement for some Medicaid beneficiaries has removed almost 17,000 people from Arkansas Works — the state’s Medicaid-funded insurance program for low-income adults — since September. Under the new rule, beneficiaries under age 50 must either prove an exemption or report at least 80 hours of “work activity” each month. Those who don’t comply for any three months in a calendar year are kicked off Arkansas Works and locked out until the new year begins.
Some health advocates have expressed alarm at the coverage losses. On Nov. 8, the Medicaid and CHIP Payment and Access Commission (MACPAC), a nonpartisan federal advisory panel, sent a letter to Medicaid officials in the Trump administration calling for a “pause in disenrollments” in Arkansas. Only a small percentage of beneficiaries reported any hours at all in October, commission chair Penny Thompson wrote. That suggests some beneficiaries aren’t aware the policy applies to them or may be having trouble using the state’s website, she said.
The governor, though, insists the requirement is working. At a September news conference, Hutchinson said cutting off beneficiaries was not the policy’s goal. He noted that he’s long defended Medicaid expansion from fellow Republicans in the state legislature who want to dismantle the program entirely. “I fought hard to maintain Arkansas Works, despite odds against it, despite enormous criticism,” Hutchinson said. The work requirement represents a “proper balance,” he said, between “providing assistance to those who need it, and … the value of work and responsibility.”
Is the requirement pushing people to re-enter the workforce? Hutchinson cited data showing many Arkansas Works enrollees had recently found employment, some of them assisted by the state Department of Workforce Services. At dozens of workforce centers around the state, DWS staff help clients search for jobs, prepare resumes, obtain scholarships and more.
Out of 21,841 Arkansas Works beneficiaries referred to DWS due to the work requirement, 1,366 have sought help at a workforce center as of Nov. 14, DWS spokesman Steve Guntharp said in an email. Some 2,887 people subject to the work requirement have found full-time employment since the requirement started. (That’s with or without DWS assistance; the number was derived from the state’s New Hire Registry, Guntharp explained.)
It’s not clear what job gains can be attributed to the work requirement, because the working poor commonly cycle in and out of employment. Guntharp said DWS doesn’t ask clients whether the work requirement motivated them to seek work or whether they were looking for a job anyway. Workforce centers haven’t seen a major rise in casework recently, he confirmed, and DWS hasn’t hired additional staff.
In its Nov. 8 letter calling for a pause in disenrollments, the Medicaid commission criticized Arkansas for not collecting better information on whether the state’s work supports are meeting people’s needs. “(D)ata currently are not being reported on the extent to which beneficiaries are accessing such services, what services they are asking or qualified for, which barriers may exist for their use of these services, and whether services are being delivered,” the letter said.
The Department of Workforce Services would not allow a reporter access to a workforce center to interview clients or staff, citing privacy concerns. When asked to be connected with Arkansas Works success stories, the agency emailed profiles of two individuals, Julia Bunch of Harrison and Jeff Snyder of Rogers, along with signed consent forms.
Snyder’s profile said he sought help from the Rogers Workforce Center after being unemployed for nine months and searching unsuccessfully for jobs. With the help of a workforce specialist, Snyder, who had recently earned his associate’s degree, found a new job Aug. 8 making $17.64 an hour. “I now work with a great company — in a job that I actually would not have gotten without the help from DWS,” he was quoted as saying.
The profile did not say whether Snyder reported being motivated by the work requirement. Moreover, this reporter could not independently confirm the details provided by DWS. The agency said it could not provide contact information for Snyder or Bunch because of confidentiality laws. Other attempts to contact either beneficiary for an interview were not successful.
Whether motivated by the work requirement or not, some beneficiaries are undoubtedly finding better-paying jobs, considering the strong economy. But not all jobs come with insurance, and making more money often means losing eligibility for Arkansas Works.
Joe Thompson, the CEO of the Arkansas Center for Health Improvement, a nonpartisan health policy center in Little Rock, said any measurement of the work requirement must take into account both income and health outcomes. “It’s not just getting a better job. … It’s a two-step process,” he said. “You want [the beneficiary] to get a better job that has insurance or buy insurance on the individual marketplace. So success needs to be not just, ‘Are they working?’ but, ‘Are they being successful in moving up that socioeconomic ladder and maintaining health insurance coverage?’ “
Since Arkansas Works was created in 2013 by Gov. Mike Beebe and moderate Republicans in the legislature, it has provided health coverage to hundreds of thousands of Arkansans. The state’s uninsured rate declined faster than almost anywhere else in the country from 2013 to 2016. Now, some health advocates fear the work requirement could erode those gains.
However, Arkansas Works was shrinking well before the work rule was implemented. Enrollment on Jan. 1 was 286,000. By Nov. 1, it had slipped to 246,000. Of the 40,000 who left Arkansas Works over that 10-month span, only about 12,000 cases were closed because of the work requirement, leaving 26,000 whose coverage ended for other reasons.
The governor has attributed that larger reduction to a strengthening economy and improved efforts at DHS to scrub the rolls of those people no longer eligible for Arkansas Works. That group include workers making too much money to qualify for the program — for a one-person household, the monthly income threshold is $1,397 — along with people who have moved out of state, inmates at correctional facilities and seniors who have become eligible for Medicare.
But it also includes cases closed for what might be called technical compliance issues, such as not responding to a DHS request for information quickly enough.
Two people interviewed for this story thought they had lost coverage due to the work requirement, but an inspection of letters sent from DHS revealed they’d been cut off because of a missing paperwork issue. DHS said it could not comment on individual cases, but its most recent report showed that almost 4,200 cases were closed in October alone because the beneficiary “failed to return requested information.” (People whose cases were closed for reasons other than the work requirement are not subject to the lockout period and may re-apply for coverage. However, if people think they were kicked off due to the work requirement, they may also assume they’re locked out.)
Kevin De Liban, an attorney for Legal Aid of Arkansas, is among the lawyers representing nine plaintiffs in a federal lawsuit seeking to undo the state’s work requirement. (The National Health Law Program and the Southern Poverty Law Center are also working on the suit.) DeLiban said Legal Aid has seen an increase in people kicked off for failing to provide DHS with verification of income or other household information within 10 days of receiving notice, as the agency requires.
“In many cases they did, it just wasn’t processed in time. Or maybe they provided it on day 11 or 12, but their case was already set to be closed,” De Liban said. “It’s immensely confusing, because it’s more and more administrative hoops to jump through and figure out. … Some people might have reported (work hours), or might not have, but then they get kicked off in the meantime for something other than the (work) requirement.
“And so it’s, if they don’t get you through the work requirements, they might get you through the verification procedures or the returned mail,” he said. “At least from our clients’ perspective, it seems like the state is trying to make it as hard as possible for people to retain coverage.”
This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. It is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.