Arkansas Data are Clear – Trump’s Medicaid Policy is a Dangerous Failure

The primary focus of the Trump Administration’s approach to Medicaid has been to encourage states to impose work and “community engagement” requirements on adults in Medicaid through Section 1115 Medicaid waivers. As regular readers of SayAhhh! know, Arkansas is the first state in the nation to impose these new rules on its Medicaid expansion policy. Just this week, Secretary Azar promoted this misguided and dangerous approach as he spoke at the National Association of Medicaid Directors.

We’ve been keeping close track of these numbers and unfortunately our worst fears are being realized. As of November 1, the state report shows that 12,277 people in Arkansas have lost coverage because they failed to report work hours online for three months in a row. And they are now locked out of coverage until January 1, 2019.

Also chilling, the latest round of numbers released by the state show that 6,002 Arkansans have two strikes against them, so thousands of them will lose coverage on December 1 if they don’t report for this month. And starting January 1 the state will extend the new rules to Arkansans aged 19 to 29 years old – all of whom are currently exempt – so the coverage losses will continue to mount.

Many of these folks are probably unaware of the fact that they have lost coverage and will only learn that they are uninsured when they next need to fill a prescription or show up at a doctor’s office or clinic for care.

The premise of this policy is flawed to begin with, as sicker people are less able to work.

Meanwhile, the policy is an abject failure with respect to its stated purpose, which is allegedly to incentivize more people to work. How can threatening to take away health coverage work if those who are targeted don’t even know they are subject to the new rules? The proponents are, however, succeeding in depriving thousands of people of the economic and health benefits of having health insurance.

For any kind of incentive policy to work, those targeted by it must be fully informed of the decisions they face. The state’s data continue to show that the vast majority of those affected by this policy are likely unaware that the new rules are in place. Of the approximately 69,000 folks affected by the reporting rules, more than 3/4ths (just shy of 54,000) are being exempted by the state’s computer system without any action by the beneficiary. Most are exempt because they are already working, are parents, or are medically frail.

Of the remaining 15,000, over 12,000 have not satisfied the reporting requirement. This is the group that is losing coverage. Of the small number (1,525) who are newly reporting work activities, about 2/3rds (968) are merely reporting that they are meeting the pre-existing work requirement for the SNAP program.1

This leaves us with 557 people newly reporting work or community engagement activities — less than one percent of those in the targeted group of 69,000.

Yet more than 12,000 Arkansans and counting are now uninsured.

  1. See p. 5 of the state’s data.
Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.