18,164 off Medicaid in 6 months of work rule

The first six months of the work requirement for Arkansas’ Medicaid program ended with 18,164 people being kicked off for noncompliance, including more than 1,200 who lost coverage Jan. 1, the state reported Tuesday.

The enrollees who have lost coverage so far represent about 47 percent of the 38,000 enrollees the state initially estimated would be subject to the requirement in 2018 and not automatically exempt based on information in state records.

The state phased in the requirement last year for Arkansas Works enrollees age 30-49 and began phasing it in this month for those age 19-29.

To meet the requirement, 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 or over the phone, an option that was added last month.

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

Enrollees who lost coverage last year as a result of noncompliance, including the 1,232 who lost coverage Jan. 1, are eligible to re-enroll with a clean compliance record for 2019.

But so far this month, only 966 enrollees have done so, including three who qualified for Medicaid but are no longer in Arkansas Works.

Arkansas Works covers adults who don’t qualify for other types of Medicaid and who have incomes of up to 138 percent of the poverty level: $17,236 for an individual or $35,535 for a family of four.

Despite the terminations, overall enrollment in Arkansas Works from Dec. 1 to Jan. 1 increased by 15 people, 234,385 to 234,400.

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

Bruno Showers, a senior policy analyst with Arkansas Advocates for Children and Families, said the low number of Arkansans who have re-enrolled “speaks to our ongoing concern that a lot of those who are getting kicked off just aren’t aware of the requirements.”

Some people may still not be aware that they lost coverage, he said.

“Most people don’t really think about their health care very much until there’s a major emergency,” he said.

Kevin De Liban, an attorney with Jonesboro-based Legal Aid of Arkansas, said some enrollees may have been discouraged by difficulties complying with the requirement.

His group is one of three advocacy organizations challenging the requirement in a lawsuit in federal court in Washington, D.C.

“People receive the message loud and clear that the state doesn’t want them to have health insurance,” he said. “The state is making them jump through more hoops to regain coverage that they very well may end up losing again because of the work requirements and the onerous reporting system.”

Amy Webb, a spokesman for the state Department of Human Services, said enrollees receive a notice when their coverage is terminated informing them that they may be eligible to re-enroll, starting Nov. 1, for coverage that takes effect the next year.

The state isn’t planning to do any additional outreach to those enrollees, she said.

The requirement is the first to be implemented for a state Medicaid program. In June, a federal judge in Washington, D.C., stopped a similar requirement from taking effect in Kentucky the next month, saying President Donald Trump’s administration hadn’t considered how the requirement would affect the Medicaid program’s goal of providing health coverage to low-income people.

The same judge is presiding over a lawsuit challenging Arkansas’ requirement on the same grounds.

Of the 60,680 enrollees who were subject to Arkansas’ reporting requirement in December, 54,011 were exempt that month based on information in state records as of Nov. 8.

Such exemptions apply, for instance, to enrollees whose incomes indicate they are working at least 80 hours a month at the state’s minimum wage, which increased Jan. 1 from $8.50 to $9.25 an hour.

Other exemptions apply to enrollees with a dependent child in their home or who were covered by the traditional Medicaid program, rather than a private plan, because they were considered to be “medically frail.”

An additional 849 were deemed in compliance because they met the work requirement for the food stamp program.

Only 462 enrollees met the requirement by reporting hours of work or other approved activities, such as volunteering.

An additional 582 reported an exemption for December that was recorded after Nov. 8.