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Challenges to Arkansas' Medicaid work requirement, explained

by Arkansas Democrat-Gazette | December 8, 2020 at 11:05 a.m.

This story is a part of The Article, your guide to Arkansas news and culture, presented by the Democrat-Gazette. Sign up for The Article's twice-weekly newsletter here.

The United States Supreme Court decided Friday it will review a lower court’s ruling striking down Arkansas’ work requirements for some Medicaid recipients.

Back up: Who does the requirement and the case affect? The work requirement relates to the Arkansas Works program and its recipients, who receive private health insurance paid with Medicaid dollars.

What is Arkansas Works? The 2010 Patient Protection and Affordable Care Act gave states the option to expand the use of Medicaid to provide health insurance to more people, and then-Gov. Mike Beebe, a Democrat, took advantage of the opportunity.

Many Arkansans ages 19-64 with a household income of up to 138% of the Federal Poverty Level became eligible for what is now known as the Arkansas Works program.

Later, Gov. Asa Hutchinson, a Republican, took office and urged the Legislature to keep the program in place, though the state tried to add the work requirement through a waiver subject to federal approval.

The Obama administration declined to approve the requirement, but the Trump administration approved it in 2018.

What is the work requirement? The work requirement made receipt of insurance contingent on the individual working or doing other approved activities, such as volunteering.

Attorney General Leslie Rutledge said in court documents the purpose of the waiver was "to test the hypothesis that conditioning Medicaid expansion benefits on work, education, or volunteering would lead to healthier outcomes for its beneficiaries."

The requirement resulted in more than 18,000 people losing their health coverage over a nine-month period.

Recipients were told to use a state website to check in, but many did not have internet access, had difficulty using the website, or didn't understand they needed to report in, according to an advocate.

What have lower courts ruled on the work requirement?

A U.S. District judge struck down the rules in 2019, writing that the federal Health and Human Services secretary exceeded his authority in approving the requirements by failing to consider how they would affect the Medicaid program's goal of providing health coverage to needy people.

Three U.S. Court of Appeals judges later unanimously agreed the Department of Health and Human Services violated federal law in approving the project without considering its effect on Medicaid coverage.

What happens next? The Supreme Court said it will consider the rulings of the lower courts, but with the requirements subject to federal approval and Democrat President-elect Joe Biden set to take office in January, the issue may become moot.

Read more about the work requirement and court case here. To learn about how to enroll in Arkansas Works or in insurance through the Affordable Care Act marketplace, check out this story from our series Grown, about how to adult in Arkansas.


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