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Arkansas' Medicaid-work rules start today

Initially, mandate to affect 27,000 enrollees ages 30-49 by Andy Davis | June 1, 2018 at 4:30 a.m. | Updated June 1, 2018 at 1:28 p.m.

Starting today, some people covered by Arkansas' expanded Medicaid program will have to spend 80 hours a month on work or other approved activities if they want to keep their coverage.

The requirement went into effect for an initial 27,000 enrollees between the ages of 30 and 49, state Department of Human Services spokesman Marci Manley said in an email.

Of those, 16,000 qualified for automatic exemptions based on information in state records. Those automatically exempted, for instance, include enrollees living with dependent children or who earn at least $736 a month. That cutoff is based on the average monthly income of someone making the state's minimum wage of $8.50 an hour and working 20 hours a week.

The remaining 11,000 enrollees will have to use a state website,, to report whether they qualified for exemptions or spent the required amount of time on work or other activities.

About 4,000 of them have created accounts on the website allowing them to make the reports, Manley said.

Those who fail to meet the requirement for three months during a year will lose their Medicaid coverage for the rest of the year.

The work requirement will be phased in for other enrollees ages 30-49 from July through September and next year for those ages 19-29.

When it is fully implemented, a total of about 167,000 enrollees in the expanded Medicaid program, known as Arkansas Works, are expected to be subject to the work requirement, which applies only to enrollees with incomes up to the poverty level.

That amounts to about 98,000 enrollees ages 30-49 and 69,000 ages 19-29.

About 281,000 people were covered by Arkansas Works as of April 1.

Despite notices and phone calls that have gone out to enrollees, not everyone has gotten the message, said Marquita Little, health policy director at Arkansas Advocates for Children and Families.

"The biggest issue right now that we're seeing and hearing about is that people on the Arkansas Works program are not familiar with this new policy and do not know about the work requirement," she said.

In March, Arkansas became the third state to receive federal approval to impose a work requirement for its Medicaid program. Today, it becomes the first state to implement one.

Kentucky, the first state to be approved, will begin phasing in its work requirement on July 1. Indiana's requirement will take effect next year.

New Hampshire received approval last month for its work requirement, which will also start in 2019.

Arkansas Gov. Asa Hutchinson has said the work requirement will encourage unemployed enrollees to find jobs and that the number who lose coverage will be "minimal."

In a letter approving the requirement, federal Centers for Medicare and Medicaid Services Administrator Seema Verma said it "is designed to encourage beneficiaries to obtain and maintain employment or undertake community engagement activities that research has shown to be correlated with improved health and wellness."

The work requirement goes into effect today. The Human Services Department has estimated that if the work requirement went into effect July 1 -- the start of fiscal 2019 -- it would reduce the cost of the program that fiscal year by about $49 million, and cause about 20 percent of enrollees who are subject to it to lose coverage during the year. All but $3.4 million of the projected savings would go to the federal government,

A more recent estimate, based on the requirement starting today, put the potential savings at $33.9 million, with about $2.3 million going to the state.

Manley declined to answer questions about the savings estimates.

Setting up the website and other technology cost about $6.8 million, with all but $678,627 coming from the federal government, according to the Human Services Department.

The state is also spending about $800,000 on outreach to enrollees through the end of this month under a contract with the Arkansas Foundation for Medical Care, which operates a call center and has been calling enrollees to tell them about the requirement. The federal government is picking up half of that cost, according to the department.

The three insurance companies that offer Arkansas Works plans have said they will have employees who are trained to log onto the state website and fill out reports on behalf of enrollees.

Enrollees can request the assistance from Arkansas Blue Cross and Blue Shield at (800) 800-4298, from Centene at (877) 617-0390 and from QualChoice Health Insurance at (866) 838-9186.

Bo Ryall, chief executive of the Arkansas Hospital Association, said he also expects hospitals to have workers who are trained to log onto the state website on behalf of enrollees.

Still, he said, hospital officials are worried about the number of enrollees who will lose coverage and the resulting impact on the amount of unreimbursed care that hospitals must provide.

"For sure, we're going to lose some people who don't fulfill the obligations of the work requirement program," he said.

Little said she's afraid that many people who qualify for exemptions don't realize they must go to the website to report them.

For instance, enrollees who are full-time students qualify for exemptions, but must report on their status every six months.

"I think there will be a lot of people who probably meet an exemption but don't meet the reporting requirement," Little said. "We know it's a small population of people who don't qualify for an exemption and are also not currently working."

A Section on 06/01/2018

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