A work requirement for Medicaid enrollees in Arkansas has led to nearly 17,000 people losing health insurance coverage, according to a lawsuit filed in December.

Arkansas is one of four states (along with Indiana, Kentucky, and New Hampshire) that have been grated waivers by the Centers for Medicare and Medicaid Services (CMS) for work requirements in Medicaid expansion plans under the Affordable Care Act (ACA). Seven other states are currently seeking similar work requirements.

Under the ACA, 33 states expanded Medicaid insurance coverage, with the federal government picking up the majority of the costs of expansion. Other states declined to expand coverage, in most cases citing potential costs in the future. However, under the Trump administration, several of those states have requested waivers allowing them to tie Medicaid expansion to work requirements, a change that had not been allowed by CMS in the past. These states say work requirements will make Medicaid expansions more fiscally sustainable, while encouraging state residents to seek employment.

In the Arkansas case, residents of the state who qualify for the Medicaid expansion must also spend 80 hours a month on work, volunteering, or other approved activities. They are required to report their work activities through a state website or over the phone.

The Arkansas lawsuit opposing the plan says that U.S. Health and Human Services Secretary Alex Azar failed to adequately consider the effect the requirement would have on the Medicaid program's goal of providing health coverage for low-income people when he approved the requirement.

A story in Politico outlined some of the challenges of the new work requirement, saying the state relies on outdated technology and does not provide adequate help to those whose coverage could be terminated.

“I have pre-existing conditions. But all they could tell me was, 'Sorry, you didn't comply,” said Jamie Deyo, who lost coverage and has ongoing complications from a 2013 car accident. “It just was a slap in the face.”

Deyo is one of nine plaintiffs in the lawsuit, filed by National Health Law Program, the Southern Poverty Law Center, and Jonesboro-based Legal Aid of Arkansas. A similar lawsuit has been filed against Medicaid work requirements in Kentucky, and advocacy groups say more are likely to follow.

The article notes that Arkansas has not hired additional workers to help Medicaid enrollees—some of whom do not have access to computers—navigate the new rules.

“Rachael Holmes said she lost her benefits at the end of October despite going to a Department of Human Services office in Little Rock once a month to log her hours,” the article said. “Holmes, who had been working at a grocery store, said it took hours just to log in to the online reporting system the first time. A state worker offered help only after a security guard noticed she was still at the office after several hours.”

In a white paper examining Medicaid work requirements, the Kaiser Family Foundation notes that although six in ten Medicaid enrollees are working, the work requirements pose other barriers—such as the reporting element. “Since one in three Medicaid adults never use a computer or the Internet and four in ten do not use email, many enrollees would face barriers in complying with work reporting requirements to maintain coverage.”

The study concludes that work requirements have generally been found to be difficult to comply with and could result in loss of health coverage for significant numbers of people.

“Many Medicaid adults face education or training limitations, but states are unable to use Medicaid funds for work support services under new waiver guidance,” the report said. “People already working or exempt from new work requirement policies may not be the target of new policies, but they will still be subject to verifying work status or navigating an exemption process that could result in eligible individuals losing coverage at high administrative expense for states.”

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Medicaid work requirements bring confusion, lawsuits

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