Current and former Arkansas Works enrollees reported being confused about the program's work requirement and in some cases unable to use a website to present their work hours or exemption status, a health-policy organization said in a report.
Although most of the 31 Arkansans interviewed in a series of focus groups were employed, none of them said the work requirement was the reason they had jobs, according to the report from the San Francisco-based Kaiser Family Foundation.
"The new requirements are not incentivizing new work or other activities in which enrollees were not already engaged, but are layering on one more thing to deal with in enrollees' already complex lives and causing added stress because no one wants to lose their coverage," the report's authors wrote.
MaryBeth Musumeci, one of authors, said the findings aren't surprising "given the complexity of the program and the change, but it's indicative of the need for even more outreach and education."
The report was released Tuesday afternoon, a day after the state Department of Human Services reported that 4,655 enrollees were kicked off the program this month for failing to meet the work requirement.
Those terminations raised the total number who have lost coverage because of the requirement, the first ever applied to a state Medicaid program, to 16,932 since the state began implementing it in June.
To stay in compliance, enrollees who don't qualify for an exemption must spend 80 hours a month on work or other approved activities and report the hours using a state website.
On Wednesday, the Human Services Department also began accepting reports over the phone at its call center, which can be reached at (855) 372-1084.
Enrollees who fail to meet the requirement for three months during a year are terminated from the program and barred from re-enrolling for the rest of the year.
The Kaiser foundation conducted the focus groups in Little Rock and Monticello last month with the help of the PerryUndem research and polling firm.
In each city, researchers spoke with one group of current and former enrollees age 30-49, who are currently subject to the work requirement, as well as a group of enrollees age 19-29 who will become subject to the requirement when the state phases in that age group next year.
"Most had had stable addresses and phone numbers for some time, although one was homeless, living out of a car, and another lived in a halfway house," the authors wrote.
Despite "robust outreach efforts" by the state, many enrollees didn't fully understand the requirement and were confused by the letters about it they had received from the state, the authors wrote.
"Many said their lives are busy and complicated, and they put the letters aside without fully comprehending the information because they had to focus on more immediate and pressing needs," the authors wrote. "For example, one enrollee said that she was focused on her alcoholism recovery and getting back on her feet, so the notices went unread.
"Others were focused on meeting basic needs like affording food and utility bills."
The state's efforts to spread the word about the requirement through outlets such as Facebook and Twitter also hadn't reached any of the enrollees, even though most said they used social media to stay in touch with friends and family members, the authors wrote.
Among enrollees who were aware of the requirement, most had trouble setting up an account on the website, access.arkansas.gov, to report work hours or an exemption.
Such exemptions are available, for instance, to enrollees with dependent children in the home, who have a short-term disability or are caring for an "incapacitated person."
When they tried to call the department for help, many "were on hold very long periods of time or transferred to multiple people before getting help," the authors wrote.
Even an enrollee who worked as a software technician "had difficulty navigating the online account set-up process and ended up losing coverage for failure to successfully report her work hours," the authors wrote.
Several enrollees also said they had trouble finding time to use the portal because it shuts down for maintenance at 9 p.m.
A lack of Internet and computer access was also a barrier. Among Monticello enrollees, a "common comment" was "not having any cellular service at home, especially for those living 'out in the country' and having to come 'into town' to get a signal," the authors wrote.
"One Monticello participant described repeatedly being unable to get her account page to load on her cell phone when she tried to report her hours," the authors wrote. "After spending an hour on the phone with DHS, she was unable to get the problem resolved and 'gave up.'"
Even those who had reported information through the website weren't sure if they had done so successfully because the "system did not provide any confirmation that reporting was successful," the authors wrote.
Among the enrollees who were working, many had unstable and unpredictable hours, and several had "changed jobs or cycled in and out of the workforce in the past year."
Some were able to work because their Arkansas Works coverage gave them access to prescription drugs that kept their chronic health issues under control, the authors wrote.
Others were unemployed "due to caring for elderly parents or physical or mental health conditions," they wrote.
No enrollees had contacted the state Department of Workforce Services for assistance, even though a department caseworker in Little Rock told the researchers she was "eager and willing to help enrollees find employment, and she also was able to assist with setting up online accounts and reporting work activities," the authors wrote.
The authors noted that the closest Department of Workforce Services office was as far as an hour and a half away for some enrollees and that most associated the department with unemployment benefits.
But they said many of the younger enrollees weren't as concerned about online reporting and were "confident [they] would be able to navigate the new requirements."
The authors also noted that the focus group participants were not representative of all enrollees because they were "more likely to have phones or email to be contacted and more likely to have access to reliable transportation to participate in the groups."
Steve Gunthrap, assistant director of the Workforce Services Department, said 1,992 Arkansas Works enrollees have sought help from the department since June 1.
Human Services Department spokesman Marci Manley said the state is planning to conduct its own focus groups, including one of people who have met the work requirement, one of people who were kicked off for noncompliance and one of enrollees age 19-29.
Next month, the department also plans to begin a paid outreach campaign, possibly including newspaper and radio ads, signs inside buses, and public-service announcements submitted to television stations, aimed at educating enrollees about the reporting requirement.
Manley said she wasn't aware of any widespread problems enrollees have experienced getting through to an operator at the department's call center or using the website, other than an "unplanned outage" affecting the site for three days in July.
"We do respond when people give us feedback," she said.
For instance, over the weekend, the department changed the website to make it easier for full-time students to claim a six-month exemption, she said.
Kevin De Liban, an attorney with Jonesboro-based Legal Aid of Arkansas, said the report illustrates how the work requirements are "a systemic failure beyond any sort of little tweaking at the edge."
His group is among three organizations that filed a lawsuit in federal court in Washington, D.C., contending that President Donald Trump's administration exceeded its authority under federal law when it approved the requirement in March.
To punish a small percentage of enrollees who aren't working or eligible for an exemption, the state has ended up taking away coverage from many more who simply fail to meet the reporting requirement, De Liban said.
"There's just no way to effectively implement the system to be able to identify noncompliant people with total accuracy," he said.
A Section on 12/20/2018