Former Arkansas Surgeon General: New Medicaid Work Requirement A Political Necessity

Jul 6, 2018

Dr. Joe Thompson is former surgeon general for Arkansas.
Credit Arkansas Center for Health Improvement

It's likely that thousands of Medicaid enrollees in Arkansas did not meet a deadline to report whether they are fulfilling new work requirements being implemented by the state. 

The Arkansas Division of Human Services told KUAR on Thursday that, as of June 29, only 370 of the 8,534 enrollees were in compliance. Enrollees had until Thursday, July 5, to log in to the state website and report their activities.

Updated totals on the number of enrollees who did not report their information by the July 5 deadline are expected to be released next week. 

Those who fail to report their activities for three months over a 12-month period will lose their coverage. 

Dr. Joe Thompson, who served as chief health officer and surgeon general to Governors Mike Huckabee and Mike Beebe, says the new requirements will serve as a test of what should be expected of those receiving public assistance and what will truly improve their situation.

Dr. Thompson currently serves as the president and CEO of the Arkansas Center for Health Improvement (ACHI), a health policy and research organization. He spoke with KUAR about the new rules, which require enrollees between the ages of 30 and 49 to spend 80 hours a month on work or other approved activities.

Karen Tricot Steward:

So the estimate is that more than 8,000 Arkansas Works enrollees are now out of compliance because they have not logged in to the state website, as required, to report their work activities or show why they are exempt. What are your thoughts on that?

Dr. Joe Thompson:

This is the initiation of a major new program under federal authority to test whether work requirements help individuals increase their upward social mobility. We know income is associated with health. As with any major program like this, getting education out and getting understanding accomplished and helping people operationally manage the new requirements is always going to be a challenge.

Steward:

And so where do we go from here? More education?

Thompson:

So I think the department, as well as the qualified health insurance plans within which these individuals are receiving care, are trying to reach out to those that are subject to and have not yet signed up for the work requirement. I know there are a number of advocacy and faith-based organizations that are similarly trying to help people do what is necessary to maintain their coverage.

This obviously is the first month - Arkansas implemented the first of June - so this is the first month of the new requirement and an individual has to fail to document their work or community service three times before they are placed at risk. So I think this is an important date for people to avoid the first strike, but unfortunately it sounds like we are going to have several thousand folks potentially not meet the first month’s requirement and go into jeopardy, needing to make sure that they meet work requirement documentation in the future.

Steward:

The governor told me that it’s expected that the number of Arkansas Works recipients will drop because some perhaps weren’t qualified in the first place or their situation has changed. What do you think about that?

Thompson:

There’s no question that our lower-income population has many, many challenges and many transitions in their experience. We did a study when Governor Hutchinson first came into office looking at individuals who signed up and on the date of their application said they had zero income. We looked at the year before and the year after at their work history and two-thirds had had work at some point in time. So it’s a very fluctuating population. In that, I think you do have people who come on and come off the Medicaid rolls. I think the open question is ‘Is this going to help people engage in the work environment and not need Medicaid in the same levels that people have in the past’?

Steward:

And so overall you are supportive of the work requirement? Is that true?

Thompson:

I think this is a political necessity. I say that because as we expanded Medicaid up to about $35,000 a year, the median household income in Arkansas is $42,000 a year. So we expanded a public support program up into the middle income part of the state’s population. We are a relatively poor state.

We have many families who are not eligible for the Medicaid expansion, but they see their neighbors being eligible. So I think we have an open philosophical question of what should be expected of individuals that are receiving public assistance. I wouldn’t say that I’m necessarily supportive, but I think the environment requires a consideration and the state is doing its best to explore and to try this.

We need to make sure we have a full evaluation to make sure that the primary goal of the Medicaid program to help individuals that have healthcare be able to have a funding source for those is maintained with the secondary question of whether the work requirement improves people’s social circumstance.