By Harris Meyer
Modern Healthcare, November 15, 2018
Nearly 4,000 Arkansans lost their Medicaid expansion coverage in October because they failed to comply with the state’s new work requirement, joining 8,462 other low-income adults who lost benefits in the previous two months.
State officials reported Thursday that 3,815 of the 69,041 people subject to the so-called community engagement requirement in October were noncompliant for three months and were dropped from Medicaid. They will lose coverage for the rest of 2018 and can only reapply in January.
The total number of people cut off of coverage in October in the state’s Medicaid expansion program, dubbed Arkansas Works, was 15,081.
Of that number, 25% were axed due to noncompliance with the state’s requirement that they spend at least 80 hours a month working, volunteering, going to school or receiving job training, while 28% were dropped because they failed to supply the requested information.
The state said 6,002 additional people have been noncompliant for two months and are at risk of losing their coverage at the end of November.
Only about 1,525 of the 69,041 people subject to the work requirement in October reported meeting the 80-hour-per-month work requirement.
Total enrollment in Arkansas Works now stands at 245,553, down 12% from 279,602 when the work requirement started in May.
Arkansas Gov. Asa Hutchinson said in September that the program’s goal is to boost labor participation and increase work training and assistance to able-bodied people who want to work. The Republican cited state data showing that about 1,000 people gained job training or employment as a result of the program.
But experts and provider groups have expressed alarm about the coverage losses and the viability of the state’s complex work and reporting requirements. Beneficiaries can only report through an online portal.
The Arkansas Hospital Association has said it would like to see the requirement halted. Providers fear the new system will disrupt care for people with chronic conditions and drive up uncompensated-care costs.
In June, (U.S. District Judge James) Boasberg invalidated the CMS’ approval of a similar requirement waiver in Kentucky on the grounds that the agency did not adequately consider its impact on coverage. Following that ruling, the CMS held a new public comment period on the Kentucky waiver and is expected to re-approve it in some form.
Two other Republican-led states, Indiana and New Hampshire, also received CMS approval this year for a five-year demonstration waiver to establish a community engagement requirement. Their programs haven’t started yet.
Ten other states have requests pending to establish similar Section 1115 demonstrations.
In addition, there are discussions in Idaho, Nebraska and Utah, three states where voters just approved Medicaid expansion, about including a work requirement. Similar discussions are taking place in Montana, where voters just shot down a tobacco tax to fund a renewal of Medicaid expansion, and in Alaska, where an anti-expansion Republican was just elected governor.
The Trump administration in January encouraged states to seek work requirement waivers.
In Arkansas, beneficiaries must report that they were either meeting the community engagement requirement or that they qualified for an exemption, such as for a disability. They can only report through an online portal run by the state Department of Human Services. There is no option for reporting by phone, mail or in person.
Enrollees may be hard to reach by phone due to unstable housing or other factors, and a large percentage lack email or internet access. In addition, the online reporting process is complicated and confusing, even to advocates and providers that have tried to help beneficiaries.
“The most likely reason for noncompliance is that (Medicaid expansion enrollees) simply do not know about the new requirements or else do not know about or understand the online portal they need to navigate in order to successfully comply,” said Bruno Showers, senior policy analyst at Arkansas Advocates for Children and Families.
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Comment:
By Don McCanne, M.D.
Two common problems for which there is a legitimate role of government in intervention include impaired access to health care for low-income individuals, and difficulties with finding and keeping adequate employment.
What is difficult to understand is why bizarre ideological concepts are allowed to displace need. In this instance, failure in one endeavor – lack of success in finding employment – is used to penalize the other – taking away health care merely because the patient lacks employment.
People by the thousands are losing health care because of this nutty idea. Instead of stepping in and correcting the problem, our current government ideologues are expanding this punishment of depriving people of health care.
The two problems are separate and require different solutions. We won’t discuss here the complex problem of ensuring optimal rates of employment, but we certainly can and should comment on the health care issue.
Everyone who needs health care should have it. We have an excellent understanding of the policies that would ensure health care for everyone. Simply enacting and implementing Single Payer Medicare for All would do it.
It’s not that we should reject ideology in our policy decisions. Rather it is that we should make efforts to get the ideology right. Ensuring health care for everyone is clearly the right thing to do – an ideological concept representing a moral imperative. Using the deprivation of health care as a punishment for failure of other unrelated policies represents an ideological perversion.
We can get this right. Enact Single Payer Medicare for All, and then separately continue to address our issues with chronic and recurrent unemployment. All we voters need to do is select government stewards who understand and support the ideology of our moral imperatives.
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