Earlier this week, Arkansas released the latest round of data showing that their misguided policy requiring adults to prove they are working in order to retain Medicaid coverage is continuing to fail. In December, 4,655 people lost health insurance, bringing the total coverage losses to nearly 17,000 so far, though thousands more will lose coverage at year-end. People started losing coverage back in September, and for those unlucky enough to lose coverage right away, they’ve been unable to re-enroll for months due to the punitive lockout provision which requires people to wait until the following January to reapply.
Looking ahead to next year, the news for Medicaid beneficiaries in Arkansas will be mixed at best. In early January, thousands more will lose coverage. But, for those who lost coverage in 2018, they could reapply as long as they are aware of this – which is a big if. These “lucky” people would have to jump through all the hoops to apply again – the state is not conducting automated renewals – and if they continue to struggle to meet the work reporting requirements, they stand to lose coverage again beginning April 1. At that point, they would be locked out for the remainder of 2019.
To make matters worse, Arkansas is set to expand these requirements to a whole new group of beneficiaries starting in January. Initially, the requirement to report at least 80 hours of work per month was limited to individuals ages 30 to 49, but in 2019 the state will expand the requirement to those ages 19 to 29. With more beneficiaries subject to the work reporting requirement next year, we can expect the coverage losses to continue to mount.
As with prior months, the most recent data show that only a tiny fraction (less than one percent) of those subject to the work reporting requirement are actually reporting new work. The vast majority are exempt from reporting after state data matches and of those reporting, most are reporting compliance with the pre-existing SNAP requirements. The figure below from the Kaiser Family Foundation (KFF) says it all.
So while it’s clear that thousands of people are losing coverage each month, it’s also clear that this requirement isn’t serving its intended purpose to encourage more work. And sadly we won’t ever know if this demonstration project is meeting its goals because despite federal law requiring an evaluation, there is none. The failure to have an evaluation – or even a clearly stated hypothesis – was one of the factors that led to the Medicaid and CHIP Payment and Access Commission calling on the Secretary to press the pause button.
As we approach the holidays it’s important to remember that this is not just about compliance with the law or an academic exercise to test a hypothesis, these coverage loss numbers represent real people. KFF released a report this week documenting the experience of beneficiaries subject to the new work reporting requirements. They found that most beneficiaries are unaware of or confused by the new requirements, and for those that were aware and tried to comply, they found it difficult to navigate the process to set up an online account. Participants in the focus groups also reported that they continue to face the same challenges with work such as unstable or unpredictable work hours and few job opportunities in rural areas. The new requirements just add to their anxiety and stress.
KFF also found that for many, having health insurance through Medicaid supported their ability to work by helping control chronic physical and mental health conditions and losing that coverage has made it harder to stay employed. PBS NewsHour documented the experience of one such individual who was working and thought he did everything he needed to do to meet the reporting requirement, but found out he missed a few steps when he tried to fill a prescription for his chronic lung disease. Without access to the medication, he ended up in the hospital several times due to difficulty breathing, missed a lot of work, and ultimately lost his job.
We’re just beginning to hear stories like this, documenting the impact of this punitive policy, but we will undoubtedly hear more. Coverage losses of this magnitude impact not only the individuals losing health insurance, but also their families and their broader communities, like hospitals and other health care providers. We opposed this policy from the beginning, citing the damage it would cause, and sadly we’ve been proven right.