Arkansas Says 4353 People Losing Medicaid Coverage for Failing to Report Hours

Arkansas said Wednesday that 4353 people lost their Medicaid coverage as a result of not reporting their work, volunteer, or job training activities under new rules that require them to record hours and will now lose their health insurance for the remainder of 2018.

At a press conference, Republican Governor Asa Hutchinson said 60,000 people were subject to the requirement under Arkansas Works, which he emphasized as a job training program. Of those, 43,655 Arkansas Works enrollees met the requirement and are allowed to keep their coverage. Hours must be reported monthly; coverage is lost when the requirement is not met for 3 months.

Reporters tried to press Hutchinson on what the early coverage losses mean for the program going forward, but he would not give projections. The Arkansas requirements took effect in June, and those who lost coverage yesterday were the first group who had to report hours or face termination of Medicaid.

Under the Trump administration, CMS is portraying Medicaid as a program that serves “able-bodied” adults, and is promoting work requirements as a way to gain self-sufficiency and even better health. Health policy research, however, has not yet borne that philosophy out, finding many complicating factors in trying to understand the nuances between poor health, unemployment or low unemployment, education and more.

Arkansas was the first state to get CMS approval for its plan to impose work requirements. The state’s new policy applies to those in the Medicaid expansion pool, beneficiaries aged 30 to 49. During the press conference, Hutchinson said the number of those in the state’s Medicaid expansion plan was higher than anticipated when it began in 2014, as allowed under the Affordable Care Act.

Read more about Medicaid work requirements.

A blog post in Health Affairs last month said that the total population losing health insurance this year could be as high as 36,000, growing to around 50,000 next year, or about one-sixth of the total Medicaid expansion population in the state.

The state said from April through August, the Department of Human Services (DHS) and its outreach partners sent more than 136,000 letters and emails, made more than 150,000 phone calls, and used social media and text messaging to try to reach people who were at risk of losing coverage. They also sent people door to door.

Responding to criticism about an online-only system for reporting activities in a rural state with high poverty, the governor said DHS instituted a system where beneficiaries could call a “ registered reporter,” someone who is authorized to report on someone's behalf, or visit a county office.

However, a blog post in last week’s Health Affairs reported a low level of awareness of the new requirements among a small group of the target population who were interviewed .

Hutchinson said that some people may have willingly decided to forgo reporting and that some may not even want to be a part of the workforce.

“While many fully complied by taking advantage of work opportunities under the work requirement, there were some that either found work, moved onto other insurance, or moved out of state without notifying DHS,” said Hutchinson. “Some simply chose not to comply.”

“Personal responsibility is important. We will continue to do everything we can to ensure those who qualify for the program keep their coverage, but it is equally important that we make sure those who no longer qualify are removed,” said Hutchinson.

During the press conference, Hutchinson also said that the move will save the state millions of dollars, which he arrived at by multiplying the premium for Arkansas Works—$570 a month—by the number of people losing coverage. He said that is because Arkansas Works is not a “fee for service” program, although in commercial FFS programs, enrollees typically pay monthly premiums as well as other payments.

He called it “common sense” that the people of his state not be asked to pay that cost.

Asked by reporters about specific instances of people who may lose health insurance, such as a woman with breast cancer, administration officials said people who may have extenuating circumstances should call their county office.