After Two Months Under New Work Requirements, Thousands of Arkansans May Lose Medicaid Without Even Realizing the Rules Changed

Arkansas’s Department of Human Services released numbers on its work requirement late Tuesday and they continue to suggest that the rollout of the new work requirements policy is extremely flawed and that thousands could lose coverage by September 1.

Since this is now the second month of the work requirement rollout, a large group of people (5,426) now have two strikes against them. This is roughly 12 percent of the 45,365 people that it appears were subject to the work requirement in July.[1]

If they do not report activity in August, they will be “locked out” of the Medicaid program and not be allowed back until January 2019. In other words, even if someone was able to show work hours during the fall they are barred from returning to the Medicaid program this year. Most are likely to become uninsured. This is terrible news for them of course, but it also makes little sense from a health policy perspective – forcing people to be uninsured will result in less access to needed prescriptions and other treatments that can help to control chronic conditions such as asthma, diabetes and hypertension.

Also very troubling, in July a whopping 83 percent of people who were expected to log onto the website and report activity did not do so. This is even higher than last month, when 72 percent of people expected to take action did not. With two strikes against them, it’s clear that many beneficiaries appear to be unaware that they were even sent up to bat.

We’ve posted the state’s July data below so that everyone can see the original source, and here’s the link back to last month’s report and our corresponding blog. The state is rolling out the work requirement in stages, and over the last two months, only adults ages 30-49 have had to report 80 hours of work or other activities each month. The total number of people subject to the work requirement grew in July, and that’s because the agency is phasing in the requirement in stages for this age group between June and September.

Here’s the rundown of the July data.

In July, there were 45,365 people notified that they were subject to the work requirement and required to report their status online. Of that group, more than half, or 30,228 people, received a letter notifying them that they were exempted automatically based on “work, training or other activities” – in other words the agency’s computer did the work.[2]

So these folks (roughly two-thirds of the total of people subject to the work requirement) did not have to take any action.

That leaves a group of 15,137 people (approximately one-third) who were expected to go online and report their work hours or request an exemption. Within that group, only 844 people reported and satisfied the 80 hour-requirement to either work, go to school, volunteer, attend job training, search for a job, attend a health education class or show that they met the SNAP work requirements.

Another 1,571 people reported an exemption after receiving a notice, but there is no mention in this report of what those exemptions were – it is also not totally clear if all these exemptions were granted.

After removing the remaining 135 people who logged on and reported some work hours but not enough, the state’s data shows that 12,587 people— or 83 percent of the people expected to log on and report—did not take action.

Final data point – only 3 people requested and were granted a “good cause” exemption – a pitifully small number. The good cause exemption is often trotted out by proponents of onerous new reporting requirements to illustrate why there is no need to worry about someone falling through the cracks when they have come across an unexpected bump in the road. It’s likely that many caseworkers, providers and beneficiaries alike have no idea this good cause exemption is available.

In the last month, we’ve learned even more about why so few people are reporting their work or activity. The only way to report work or community engagement hours is to go online, yet Arkansas has shoddy internet access and researchers from the Urban Institute estimate that about 31 percent of people potentially required to report activity do not have internet in their homes. Moreover, the agency only allows people to log onto the website between 7am and 9pm.

It’s clear from these two months of data that the rollout is not going well. That’s part of the rationale for a lawsuit filed by several Arkansas Medicaid beneficiaries yesterday requesting that a D.C. Circuit judge order HHS Secretary Alex Azar to reject Arkansas work requirement waiver. You can read the complaint here.

[1]Arkansas reports that 43,794 people were subject to the work requirement, but this does not add up. It appears to leave out the 1,571 people who reported an exemption after receiving a notice. If so, the correct total of people subject to the work requirement is 45,365 (43,794 +1,571). The calculations in this blog are based on the understanding that the true universe of people notified was 45,365.

[2]Reasons for automatic exemptions are detailed on page 4, which shows that 13,951 of people exempt from reporting their work or activities are already working 80 or more hours. The other automatic exemptions included having a dependent child in the home (4,192), being medically frail (4,282), or meeting the SNAP work requirement (5,780).