State officials say another 3,800 enrollees fail work requirement, lose health care coverage

More than 3,800 Arkansans were terminated from the state's Medicaid expansion program this month as a result of the program's work requirement, the state Department of Human Services reported Thursday.

The terminations bring to 12,277 the number of Arkansans who have lost their health coverage because of the requirement since it went into effect June 1.

An additional 6,002 enrollees had accumulated two months of noncompliance as of Nov. 7 and risk losing coverage next month unless they meet the requirement this month.

Partly because of the terminations, enrollment in the program, known as Arkansas Works, fell from Oct. 1 to Nov. 1 by more than 7,000 people, to 245,553.

The work requirement has been challenged in federal court in Washington, D.C., and has been criticized by advocates for children and the poor.

A week ago, a federal advisory group urged U.S. Health and Human Services Secretary Alex Azar to temporarily halt enforcement of the requirement because of concerns about the number of people who've been terminated from the program.

No action has been taken on that request, and state officials disagreed with the group's assessment of roadblocks to complying with the requirement.

To meet the work requirement, enrollees who don't qualify for an exemption must spend 80 hours a month on work or other approved activities and report their activities through a state website, access.arkansas.gov. Enrollees can also use the website to claim an exemption from the requirement.

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.

Gov. Asa Hutchinson said in a statement that he is pleased that "the large majority" of enrollees met the requirement and that they "should be commended for their efforts."

"As I've stated before, others have either found work, moved onto other insurance, or moved out of state," he said. "Some chose not to comply, and that is their right. They will have an opportunity to re-enroll in January."

He said about 2,800 enrollees have started new jobs since the requirement went into effect.

"The primary goal of this initiative is to connect people with work and to help them move people up the economic ladder," Hutchinson said. "This is a good sign as we're still in the early stages of its implementation.

Kevin De Liban, an attorney with Legal Aid of Arkansas, said a lack of knowledge about the requirement and difficulty in using the state website appeared to be the main reason for enrollees' lack of compliance.

He noted that out of the 15,243 enrollees who were not automatically exempt from the requirement in October, based on information from state records or that the enrollee had reported in a previous month, only 3,115, or about 20 percent, used the state website to report a sufficient number of hours or exemption.

Another 162 enrollees used the site to report hours, but not enough to meet the requirement. The remaining 11,966 who failed to comply with the requirement in October didn't report any activities.

"There's no evidence that DHS has that suggests that people aren't working," he said. "If anything, it suggests people can't use the website."

The Jonesboro-based nonprofit is among three advocacy groups challenging the requirement in a lawsuit in federal court in Washington, D.C.

The judge presiding over the case in June stopped a similar requirement from going into effect in Kentucky, saying President Donald Trump's administration hadn't considered how the requirement would affect the Medicaid program's goal to provide health coverage to low-income people.

Arkansas' work requirement, the first such condition ever added to a state's Medicaid program, phased in from June through September for Arkansas Works enrollees age 30-49 and will be added next year for those age 19-29.

Arkansas Works covers people who became eligible for Medicaid when the state expanded eligibility in 2014 to adults with incomes of up to 138 percent of the poverty level.

The income cutoff this year, for instance, is $16,753 for an individual or $34,638 for a family of four.

Most enrollees receive the coverage through private plans, with the Medicaid program paying most or all of the premium.

Of the 69,041 enrollees who were subject to the requirement last month, 53,798 were exempt based on information from state records or that the enrollee had reported in a previous month.

Those who used the website included 557 who reported at least 80 hours of work or other activities, such as attending classes or looking for a job, and 968 who complied by reporting that they had met the food stamp program's work requirement.

An additional 1,590 enrollees used the website to report an exemption.

The most common reason for an exemption, applied to 25,425 enrollees, was because state records indicated the enrollee's income was consistent with that of someone working at least 80 hours a month at the state's minimum wage of $8.50 an hour.

Among the other exempt enrollees were 9,913 who had an exemption from the food stamp work requirement, 8,271 who were covered by the traditional Medicaid program, rather than a private plan, because they were considered to be "medically frail" and 7,147 who had one or more dependent children in the home.

Bruno Showers, a senior policy analyst with Arkansas Advocates for Children and Families, said the number of terminations shows that the state needs to increase its efforts to educate enrollees.

"The fact that so few people are reporting anything at all indicates that people just don't know about the requirement," he said.

While that might save the state money in the short term, he said, it will end up costing health care providers as more uninsured patients show up needing medical care.

Human Services Department spokesman Marci Manley said the department doesn't want the requirement to cause any enrollees to lose coverage. She noted that the number whose coverage was terminated this month was fewer than the 4,353 who lost coverage in the first round of terminations in September and the 4,109 who were kicked off in October.

She said the department is planning focus groups and surveys to find out why some enrollees failed to report. The department is also planning improvements to the website and has been meeting with college representatives in preparation for the requirement taking effect for younger enrollees next year.

"We've engaged in an unprecedented proactive outreach effort to educate beneficiaries and offer them assistance in meeting the work and community engagement requirement that has involved postal mail, email, social media, and informational displays in other government offices, among others," Manley said in an email.

A spokesman for the federal Centers for Medicare and Medicaid Services said in an email that the agency is monitoring the requirement's implementation and has "set high expectations for an independent evaluation to determine if the demonstration is delivering the results for which it was designed."

"However, we won't rush to conclusions based on early findings, but will use those to discern best practices and inform our evaluative work," the spokesman said. "Ultimately, Administrator [Seema] Verma believes that it is local leaders, entrusted with responsibility by their own communities, who are best positioned to design the right solutions for their programs."

A Section on 11/16/2018

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