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Letter advises pause of state Medicaid rule; Internet access a snag for work edict, it says

by Andy Davis | November 9, 2018 at 4:30 a.m.

Concerned about the number of Arkansans who have lost health coverage, a federal advisory panel on Thursday urged a top federal official to temporarily stop the state from enforcing its work requirement for Medicaid expansion enrollees.

In a letter to Health and Human Services Secretary Alex Azar, the chairman of the Medicaid and Children's Health Insurance Program Payment and Access Commission cited the small number of enrollees who met the requirement by using a state website to report their hours of work or other approved activities.

In September, for instance, just 1,532 met the requirement by reporting their hours. An additional 2,263 used the site to report an exemption, and 222 reported some hours but not enough to meet the requirement.

Meanwhile, 16,535 were found out of compliance because they didn't report any activities through the website.

An additional 52,714 were not required to report because information in state records showed they were exempt or indicated they were meeting the requirement.

"The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail," wrote the commission's chairman, Penny Thompson.

She said the commission is calling for "a pause in disenrollments in order to make program adjustments to promote awareness, reporting and compliance."

The nonpartisan, 17-member commission was created by Congress in 2009 to make recommendations on policies governing the health care programs for low-income people. Its letter to Azar followed a commission discussion on Oct. 25.

In a letter to Thompson six days later, Arkansas Medicaid Director Dawn Stehle said state officials were disappointed that they weren't included.

Stehle contended that a presentation to the commission included "numerous errors and flawed language that misrepresent the program as designed."

"For [the commission] to attempt to establish itself as a monitor over individual state Medicaid programs is a new and slippery path that should be reconsidered," Stehle wrote.

Arkansas in June became the first state in the more than 50-year history of the Medicaid program to implement a work requirement for some enrollees.

The requirement applies to enrollees in Arkansas Works, which covers people who became eligible for Medicaid when the state extended eligibility in 2014 to adults with incomes of up to 138 percent of the poverty level.

Most of the program's more than 252,000 enrollees receive the coverage through private plans, with the Medicaid program paying some or all of the premium.

To stay in compliance, enrollees must spend 80 hours a month on work or activities and report their hours through the website,

Those who fail to comply for three months during a year are terminated from the program and barred from re-enrolling for the rest of the year.

More than 8,400 enrollees lost their coverage in September and October after accumulating three months of noncompliance.

An additional 4,841 had accumulated two months of noncompliance as of Oct. 8 and were set to lose coverage last week unless they reported their work hours or an exemption for October. The state Department of Human Services is expected to report next week on how many ended up being terminated.

In the letter, Thompson said the requirement to report through the website "may be challenging for beneficiaries given limited Internet access in the state and the multi-stage process for establishing an account and entering information."

The lack of Internet access may also be hampering the state's efforts to inform enrollees about the requirement since "many educational resources are available only online or through social media, which is problematic given the low level of Internet access," she wrote.

Enrollees also may need help finding and keeping a job, she wrote. Although information on transportation assistance and other services is available on the Human Services Department website, she said the department isn't "directly connecting" enrollees to organizations that provide the services or collecting information on the need for such services.

Noting that the federal Centers for Medicare and Medicaid Services has not yet approved a plan for evaluating the work requirement, she said her agency also is concerned about whether officials "will be able to interpret early experience and evaluate progress towards evaluation goals."

In her Oct. 31 letter to Thompson, Stehle said that about 95 percent of enrollees who responded to calls to let them know about the requirement did not indicate that a lack of Internet access or computer literacy was a barrier to reporting through the website.

The department also is conducting focus groups and client surveys to "determine clients' knowledge, understanding and accessibility related to reporting their work requirements," she wrote.

"We have extensive engagements with stakeholders across the state in our continued efforts to educate working age adults about the community engagement requirements," Stehle wrote. "Our goal is to have everyone actively and fully engaged in these opportunities, but we also recognize some may choose not to participate."

The letter to Azar came a day after 39 health-policy professors and researchers, including the deans or associate deans of six public-health or health-policy schools, asked to submit a brief in Washington, D.C., federal court in support of a lawsuit challenging the Arkansas work requirement. U.S. District Judge James Boasberg granted the request Thursday.

Agreeing with the plaintiffs -- represented by the National Health Law Program, the Southern Poverty Law Center and Jonesboro-based Legal Aid of Arkansas -- the researchers said the federal law governing Medicaid does not allow work requirements.

They said the Centers for Medicare and Medicaid Services, in justifying such requirements, had misrepresented research on the effect of employment on the health of low-income people and ignored research on the economic benefits of expanding Medicaid coverage.

They also argued that the work requirement will reverse the state's success in reducing the number of its residents who are uninsured and leave hospitals and other health care providers with more unpaid bills.

"Even a more conservative estimate reflecting the actual current rate of disenrollment finds that between 19 percent and 30 percent of the approximately 161,000 people subject to work requirements in Arkansas, or 30,700 to 48,300, will lose coverage by June 2019, the first year of the amended Arkansas Works demonstration, clearly a devastating result," the researchers said in the brief.

A spokesman for the Centers for Medicare and Medicaid Services said the agency and Health and Human Services Department had no comment on the brief or letter from the commission.

J.R. Davis, a spokesman for Gov. Asa Hutchinson, said the state's outreach to enrollees has included appearances on television and radio news programs and thousands of letters and phone calls.

Some of those getting moved off the program may no longer need the assistance, he said.

"We believe there's a lot of individuals who have either moved on into work and have just decided not to notify DHS about that, have moved out of state or maybe moved onto a spouse's insurance," Davis said. "Until they get in touch with us and let us know, there's really nothing else that we can do."

A Section on 11/09/2018

Print Headline: Letter advises pause of state Medicaid rule; Internet access a snag for work edict, it says


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