Arkansas tries again with work requirement

Brawner

Should some Medicaid recipients be required to work, go to school, or serve in order to keep their benefits? For the second governor in a row, Arkansas says yes.

“The requirement is simple,” said Gov. Sarah Huckabee Sanders in announcing her administration’s pending waiver request before the Trump administration. “If you want to receive free health care paid for by your fellow taxpayer, (then) able-bodied, working age adults have to work, go to school, volunteer, or be home to take care of their kids.”

Sanders said 220,000 adults receive coverage through the state’s ARHOME program at a cost of $2.2 billion annually.

That’s the state program created as a result of the Affordable Care Act, otherwise known as Obamacare. The federal law expanded the number of Arkansans eligible for Medicaid to include able-bodied adults ages 19-64 with incomes of up to 138 percent of the federal poverty level.

States had the option of participating in the program as a result of a Supreme Court ruling. Arkansas chose to participate during Gov. Mike Beebe’s administration. But rather than enrolling those individuals in traditional Medicaid, it obtained a waiver from the Obama administration allowing it to use those federal dollars to purchase private insurance for them.

The program has gone through several changes in part — in the early years, in particular — to make it more palatable to dubious state lawmakers. State officials are calling this latest waiver amendment the “Pathway to Prosperity.”

Sanders said that 90,000 of the 220,000 recipients don’t have a job despite the fact that employers can’t find workers.

This will not be the first time Arkansas has sought a waiver to require Medicaid

Liexpansion beneficiaries to work. Sanders’ predecessor, Gov. Asa Hutchinson, implemented the nation’s first. In fact, he called the entire health care program Arkansas Works. Under that waiver obtained from the first Trump administration, individuals who failed to meet the requirement three months in a calendar year were subject to losing their coverage.

Whether or not the program succeeded depends on who is asked. There was definitely a big effort. It removed 18,164 recipients from the rolls in 2018. Of those, 1,910 regained coverage by the first part of 2019. Hutchinson told National Public Radio that year that the program had led 12,000 individuals to employment.

At the time, the Department of Human Services sent out a monthly summary of the program’s activities. The last one in March 2019 showed that 116,229 recipients were subject to the work requirement in February, and that 102,856 were meeting it through work, training or other activities. Of that number, 52,571 were employed at least 80 hours per month.

Arkansas Works did not last long enough to gauge its longterm effectiveness. A federal judge blocked it in March 2019, saying the work requirement did not help it achieve Medicaid’s purpose of providing health coverage.

At Sanders’ press conference announcing the waiver, Department of Health and Human Services Director Kristi Putnam and state Medicaid Director Janet Mann said the Pathway to Prosperity amendment will take into account lessons learned from the previous effort.

Those include simplified reporting requirements that tripped up some recipients. It will use data matching — comparing data from different sources — to identify individuals who need extra support. Recipients can receive focused care coordination services. Those include a personal development plan, success coaching, and connection to community resources. Individuals who don’t cooperate will have their coverage suspended but will not be disenrolled. Their benefits can be rapidly restored. Mann said there will be a focus on communication and personal contacts rather than an over-reliance on technology.

The waiver request estimates that the changes will reduce the state’s costs by $122.8 million over five years.

It seems likely that the Trump administration will approve the request. Sanders and her team believe their proposed changes, including the data matching and the suspension rather than removal of benefits, plus the presence of the new Trump administration will help ensure another judge doesn’t overturn the program.

That’s one of the two questions to be asked: Can it get through the courts?

The other is, can a work requirement work?

••• Steve Brawner is a syndicated columnist published in 18 outlets in Arkansas. Email him at brawnersteve@mac.com.