Trump administration approves punitive work requirements for Arkansas Medicaid program

By Shelley Connor
12 March 2018

The Trump administration approved Arkansas’ proposed Medicaid work requirements scheme last week, making it the third state to receive such a waiver since the beginning of the year.

The Centers for Medicare and Medicaid Services (CMS) did not decide upon other terms of Arkansas’ waiver requests, among which is a so-called partial expansion of Medicaid in the state. The state proposes that it would continue to receive the same amount of federal funding that it has received since it expanded Medicaid under the Affordable Care Act (ACA), while reducing eligibility to those on the federal poverty line. The poverty line for an individual is a laughable $12,140 for individuals and $25,100 for a family of four. The CMS could decide later to approve that part of Arkansas’ waiver. Such a decision would result in over 60,000 Arkansas residents losing Medicaid coverage immediately.

Arkansas’ new eligibility requirements, scheduled to begin on June 1, are some of the strictest since CMS began granting waivers this year. Under the plan, all adult Medicaid participants under the age of 50 will be required to work 80 hours per month or engage in work-related activities unless exempted. They must report their hours electronically on the Arkansas Medicaid portal monthly. Those with exemptions must report every two months, providing documentation that they still qualify for their exemption.

Participants who fail to meet the requirements or produce evidence of having met the requirements for three months will lose coverage for the remainder of the calendar year. This is the most punitive lockout period allowed to any state thus far.

Brad Woodhouse, the director of advocacy group Protect Our Care, has called Arkansas’ new rules “draconian.” In a statement following the CMS’ approval of Arkansas’ new requirements, Woodhouse called the monthly paperwork requirements “onerous,” and said that the plan “breaks new ground in needless and ideologically-driven cruelty.”

According to the Center on Budget and Policy Priorities (CBPP), the new requirements will effectively force many eligible people off the rolls simply because they lack internet service. According to the CBPP, “electronic reporting will pose a particular challenge for people without Internet access. In Kentucky, 19 percent of non-elderly adult Medicaid enrollees lack any Internet access, and 42 percent don't have broadband access, recent research shows; access to the Internet in Arkansas is likely similar.”

As the CBPP also points out, “Studies show that red tape and paperwork requirements reduce enrollment in Medicaid; getting doctors’ letters or other proof will be burdensome both for enrollees and providers, even more so when it’s required every two months.”

Such requirements will put a burden upon caregivers and the disabled to pursue more frequent doctor’s visits, which in turn will eat into their allotment of doctors’ visits imposed by Medicaid.

Arkansas Governor Asa Hutchinson cloaks his intentions to gut Medicaid in the same moth-worn jargon that the ruling class always employs when it sets out to destroy social programs. “This is not about punishing anyone,” he stated. “It’s about giving people the opportunity to work.” According to Hutchinson, these policies are designed to move poor people “up the economic ladder.”

Hutchinson failed to mention the fact that, as in other states, most of Arkansas’ Medicaid participants—fully 60 percent—currently work. Moreover, an abundance of studies have shown that Medicaid coverage actually allows more people to work and to work more productively.

Additionally, as the CBPP analysis points out, not all workers have a steady schedule from one month to another; “…a retail worker who can’t get 80 hours of work in the slower sales months after the Christmas holidays could fail to meet the requirement for three months early in the year and lose coverage for the rest of that year,” the CBPP notes. These requirements will unnecessarily burden those workers with little job security, jeopardizing their ability to address health concerns in a timely way. In turn, their ability to continue working will be negatively impacted.

Physicians’ groups such as the American Psychiatric Association (APA), American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP), among others, have spoken out emphatically against schemes that would reduce Medicaid eligibility. In January, those groups issued a statement pointing out that “Imposing work requirements, lock-outs, premiums, and other out-of-pocket costs will limit access to preventive and primary care services and inhibit Medicaid beneficiaries from seeking care that helps them avoid costlier health conditions and maintain wellness.”

Hutchinson, however, is not concerned with such troublesome facts. “We did not want to wait on a full analysis,” Hutchinson told the press on Monday. “[W]e wanted to get this work requirement in place.” He purposely eschewed the fact that the analyses have already been made, and that they have unwaveringly failed to support his claims.

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