More on Medicare & Medicaid

Coverage losses, confusion in Arkansas months after state implements Medicaid work requirements

Not only were there no employment changes, but Medicaid coverage rates have been dropping due to confusion and lack of awareness.

Jeff Lagasse, Associate Editor

Thousands of adults in Arkansas lost insurance coverage in the first six months after Medicaid work requirements were implemented, with no change in employment, according to a new study from Harvard T.H. Chan School of Public Health.

The study, published in the New England Journal of Medicine, provides quantitative evidence on the nation's first-ever work requirements in Medicaid, which started in Arkansas in June 2018.

The idea behind work requirements is to shepherd people into jobs and by extension into private health insurance, but that has yet to happen in Arkansas. Not only were there no employment changes, but Medicaid coverage rates have been dropping -- due largely to confusion around the process, or a lack of awareness generally about the new requirements, the authors said.

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The researchers conducted a telephone survey in late 2018 among low-income citizens ages 19-64. About half of the respondents were from Arkansas, while the others were from comparison states -- Kentucky, Louisiana and Texas -- that had not implemented work requirements.

They found that the policy was inked to significant reductions in insurance coverage for the 30-49-year-olds targeted by the policy, but not among people in other states not subject to the rules. While the state itself reported that the policy led to 18,000 adults leaving Medicaid in late 2018, it wasn't clear what had happened to them, and defenders of the program have argued that most probably got coverage through new jobs. The study showed that a large portion of this group had not gained other coverage and had become uninsured.

In addition, more than 95 percent of the low-income individuals in Arkansas subject to the policy were already meeting the work requirements -- either working 80 hours a month or participating in a community engagement activity such as job training -- or should have been able to gain an exemption (based on disability, childcare, or other factors).

But one third of this group hadn't even heard of the requirements, particularly among those with less than a high school degree, and only half were reporting the required information online to the state in order to keep their coverage, primarily due to confusion about the process or lack of internet access. This suggests that many lost coverage due to confusion and red tape, said said Benjamin Sommers, lead author of the study and professor of health policy and economics.

"Many more states are considering work requirements, and the Trump administration has been eager to support that effort," said Sommers. "With these sorts of broad social policy changes, it's really important to have evidence afterwards to see whether they're working as intended. Based on our results so far in Arkansas, it doesn't appear that this particular policy is accomplishing its goals."


Democratic representatives criticized work requirements last summer, decrying the potential effect on low-income families and loss of health coverage.

In particular, Representatives Elijah Cummings, ranking member of the Committee on Oversight and Government Reform, and Raja Krishnamoorthi, ranking member of the subcommittee on Health Care, Benefits and Administrative Rules, penned a strongly worded letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma demanding information on how work requirements will affect low-income families and whether they violate Title VI of the Civil Rights Act.

Twitter: @JELagasse

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