Work Requirements For Arkansas's Medicaid Program Approved By Trump Administration

Mar 6, 2018

Gov. Asa Hutchinson with CMS Director Seema Verma holding a signed and approved waiver for Arkansas's Medicaid program.

The Trump administration’s Centers for Medicare and Medicaid Services has at long-last made its decision to add a work requirement for certain low-income people if they way to keep getting health insurance through Arkansas’s version of Medicaid expansion, known as Arkansas Works. The announcement was made Monday at the state’s Capitol building.

CMS Director Seema Verma personally signed and hand-delivered the federal agency’s letter to Governor Asa Hutchinson granting the state’s request.

“It’s my aim and the aim of this administration, with President Trump and Secretary Azar to really change how CMS is working with states. We are committed to working with states and being true partners with where they want to go,” said Verma.

It’s been nearly a year since the governor first requested, and the Legislature backed, the work requirement waiver.  It’ll impact some 70,000 Arkansans out of 286,000 or so enrolled through Medicaid expansion.

“This is good news for Arkansas because this is not about punishing anyone it’s about giving people an opportunity to work. It’s to give them the training that they need, it’s to help them to move out of poverty and up the economic latter,” said Hutchinson. “That is the objective of it.”

The Obama administration routinely denied work requirements, saying they were antithetical to the point of Medicaid – which is to make sure poor people have health insurance. The Trump administration already granted Kentucky and Indiana a work requirement add-on but Hutchinson promises Arkansas will be the first state to implement the new concept.

“That is because we’re ready with our systems. This will be going fairly quickly and we’ve got our processes down,” said Hutchinson.

It’ll be implanted in two phases. The first group of 30-to-49 year olds will first be notified March 15th and will be required to begin work-related activities June 1st if they want to keep Medicaid coverage. About 39-thousand people don’t meet current exemptions. Enrollees must work 80 hours a month in some combination of work, school, volunteering, job training, or job searching. CMS Director Verma says “reasonable exemptions” have been made.

“There are exemptions for people that have substance abuse disorder, there are exemptions for parents that are perhaps taking care of a child, and there are some age exemptions as well. So, I think they’ve done a really good job of thinking through some of the individuals that may or not be able to participate in the workforce or community engagement,” Verma said.

And then in 2019, another 30,000 enrollees between the ages of 19 and 30 will face the new restriction on insurance coverage.

While the governor and Director Verma believe the work requirement will help people get gainful employment, and move to employer-based healthcare, others like Marquita Little, the Health Policy Director at Arkansas Advocates for Children and Families, aren’t so sure.

“It definitely is potentially punitive in nature. Should a person fail to meet the requirement or if they just fail to certify or confirm they’re exempt, it’s three times they can miss that, and we know that as the systems become more complex often times that alone creates barriers…and so our concern is that someone who might even meet the exemption fails to confirm it. They would potentially lose their coverage for a year,” said Little.

The American Lung Association released a statement worrying that it’ll particularly hurt a sickly state.

“Arkansas has the third highest lung cancer incidence rate in the country and its adult smoking rate of 23.6 percent is also one of the highest in the country. This waiver will simply make these grim statistics worse, as fewer people will receive treatment to quit smoking and screenings to detect lung cancer at an early and more survivable stage.”

The association notes a detail overlooked at the governor’s press conference, that even those who do meet exemptions will now get less services, “Those patients that still qualify for Medicaid after this waiver will lose access to the non-emergency transportation benefit - making it more difficult for patients who struggle to breathe to keep their appointments and get the care they need.”

Federal approval of the new restrictions to the Affordable Care Act-enabled expansion of Medicaid comes at a time when Republicans in the Arkansas Legislature or struggling to secure enough votes within their own caucus to reauthorize the program. Senate Majority Leader and next session’s Senate President Jim Hendren, a nephew of the governor’s, says he doesn’t know if the new restrictions will be enough to get Republican support this week.

“I don’t know, it’s hard to get people to give me a straight answer,” said Hendren. “I think it will help and it will get us closer. But whether or not it’s going to push us over the edge, we probably won’t know until the vote is cast. We need a little drama around here right?”

The Legislature has to annually approve the state Department of Human Services budget, which includes Medicaid, with a three-fourths vote. Republicans control supermajorities in the state House and Senate. The Senate also has three vacancies this fiscal session due to a death, resignation due to criminal activity, and a member leaving to take a post in the Trump administration.

And while the state did get the work requirement waiver granted– CMS did not give the go-ahead on a second item proposed by the governor last year, to reduce eligibility from those earning 138 percent of the poverty level to 100 percent. Director Verma didn’t officially, outright deny that waiver. It was more of a non-denial, denial.

“We’re still working through some issues in that particular area but we wanted to move forward on the work requirement and community engagement piece,” said Verma.

That’s a sore spot for conservative lawmakers but a bright spot for Marquitta Little. It could have jeopardized insurance coverage for 60,000 Arkansans.

“We know that these are some of the most vulnerable Arkansans and some of the families who are struggling the most are at that income range. Our criticism of that policy is based on the fact that there’s so much uncertainty happening at the federal level that we just could not guarantee that the marketplace would offer a comparable affordable coverage option for those people if they had become immediately ineligible for Arkansas Works,” Little said.

The Joint Budget Committee is expected to vote Tuesday morning on the DHS appropriation that funds Medicaid expansion.

Editor's note: The Joint Budget Committee ended up taking up the issue after production of this piece on Monday afternoon. It passed the appropriation bill to the Senate floor which could consider it Tuesday morning.