Failure to meet work edict is set to oust Arkansas Works enrollees

5,162 on Medicaid-rule cusp

Thousands of Arkansas Works enrollees were set to lose their health coverage today after failing to comply with the program's new work requirement.

Max Greenwood, a spokesman for Arkansas Blue Cross and Blue Shield, said her company had about 2,500 customers as of Friday who were expected to lose their coverage after failing to meet the work requirement in June, July and August.

The numbers for Little Rock-based QualChoice Health Insurance and St. Louis-based Centene, which also offer Arkansas Works plans, weren't available Friday.

Amy Webb, a spokesman with the Arkansas Department of Human Services, said she didn't expect to have information on the total number of terminations until Sept. 12.

As of mid-August, 5,162 enrollees had not met the requirement for June, July or August and were at risk of losing coverage today unless they visited a state website by Friday to report their work hours or an exemption.

Greenwood said her company has been contacting pharmacists, doctors and other health care providers to let them know what to expect.

"Based on the numbers we have seen up to this point, we knew that it was going to be a substantial amount of people that were potentially impacted," Greenwood said.

In June, Arkansas became the first -- and so far the only -- state in the more than 50-year history of the Medicaid program to add a work requirement for some of its enrollees.

The same month, a federal judge in Washington, D.C., blocked a similar requirement in Kentucky from taking effect in July.

Work requirements in Indiana and New Hampshire are scheduled to start next year.

In the meantime, two of the groups that filed the lawsuit over Kentucky's requirement have filed a suit in the same court to stop Arkansas' requirement.

The lawsuit contends that President Donald Trump's administration exceeded its authority under the Medicaid law when it approved the measure.

When fully implemented, Arkansas' work requirement is expected to apply to more than half of the 265,000 people on Arkansas Works, as the expanded part of the state's Medicaid program is known.

The Legislature's expansion of Medicaid in 2014 extended eligibility to adults with incomes of up to 138 percent of the poverty level. This year, for instance, that income cutoff is $16,753 for an individual or $34,638 for a family of four. Most enrollees receive the coverage through private insurance plans, with the Medicaid program paying the premiums.

The work requirement is being phased in this year for enrollees age 30-49 and for those age 19-29 next year.

To stay in compliance, enrollees must spend 80 hours a month on work or other approved activities, such as taking classes or volunteering. Enrollees who fail to comply for three months during a year will have their coverage terminated and won't be able to re-enroll for the rest of the year.

Out of almost 44,000 enrollees who were subject to the requirement in July, 12,722 failed to comply, including 5,426 who also did not comply in June.

Most of those who were in compliance were determined to be automatically exempt based on information in state records.

Such exemptions apply, for instance, to 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.

Those not automatically exempt must visit a state website, access.arkansas.gov, to report their hours or claim an exemption.

Enrollees whose coverage is cut off today can have it restored if they report their hours or an exemption for August by 9 p.m. Wednesday. Because the Department of Human Services is closed over the three-day weekend, the soonest they can have it restored is Tuesday.

Marquita Little, health policy director with Arkansas Advocates for Children and Families, said many people probably won't realize they don't have coverage until they go to a drugstore or doctor's office.

"If someone is in the middle of a health care crisis, if they have a prescription they need to have filled, they won't have many options at all," she said.

The Human Services Department sent notices to enrollees who were out of compliance in June and July warning them that their coverage would end today unless they reported work hours or an exemption for August.

The notice mentions that the department's website contains information on charitable clinics and community health centers, which provide free or low-cost services to low-income people.

Department spokesman Marci Manley said the department also will send a notice in about a week to former enrollees with information about health centers, other Medicaid eligibility categories and subsidized coverage available through healthcare.gov to people with incomes of 100 percent to 400 percent of the poverty level.

Because Medicaid expansion was meant to be mandatory under the 2010 Patient Protection and Affordable Care Act, the subsidized coverage is not available to people with incomes below the poverty level. A 2012 Supreme Court ruling made the expansion optional for states.

J.R. Davis, a spokesman for Gov. Asa Hutchinson, said the work requirement is having its intended effect.

"The point of the work requirement was to connect people with work, to strengthen our workforce as a state and help move people up the economic ladder," he said. "We feel like that is what the work requirement is doing."

While some people will lose coverage, it's too soon to say what the impact will be, he said. Some whose coverage is being terminated may already have coverage through another source, such as a spouse's plan, he added.

Each of the three companies that offer Arkansas Works plans have employees known as registered reporters who are authorized to report work activities or exemptions on behalf of enrollees.

During visits to customers' homes, a registered reporter for QualChoice has helped customers report work hours or exemptions in the customers' homes, yards and "even in her vehicle," spokesman Matt Ramsey said. Over the past three weeks, she's made 85 visits, and submitted exemptions or work hours for 25 who were in danger of losing their coverage, he said.

The company also has attempted to reach customers through calls, emails and text messages, he said.

As of mid-August, Arkansas Blue Cross and Blue Shield's 80 registered reporters had made more than 2,700 calls to enrollees subject to the work requirement, but had only been able to reach 225, Greenwood said. She said the company has also sent a 19-page flier to doctors and pharmacists with details on how to report hours and exemptions.

Angel Carver, 42, who lives at a homeless shelter in Little Rock, said she received a notice that she will need to start complying with the work requirement in September.

She told Paul Atkins, associate pastor at Canvass Community Church in Little Rock, which serves dinner to more than 100 homeless people every Wednesday.

"He said don't worry about it," she said. "That way it kept me from my anxiety getting too high and everything."

Using the information on the notice, Atkins, who is also an insurance agent, helped Carver create an account on the state website allowing her to report her hours or exemption status.

She said she expects to be able to meet the requirement using the hours of volunteer work she puts in at the church and the shelter.

The homeless also can apply for a "good cause exemption" by calling a Human Services Department county office or sending an email to AWGoodCauseRequest@dhs.arkansas.gov.

Through Arkansas Works, Carver said she's able to fill prescriptions for several chronic health conditions and see a variety of specialists, including a hematologist, an orthopedist and a neurologist.

"It's very important for me to keep my insurance," she said.

A Section on 09/01/2018

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