Work requirement drops another 4,100 Arkansans from Medicaid in October

Governor Asa Hutchinson
DECLINING ROLLS: Governor Asa Hutchinson says noncompliance with the work requirement is a choice (file photo).


In a report released Monday, the state Department of Human Services said it had terminated the health insurance of another 4,109 individuals due to Governor Hutchinson's work requirement for certain beneficiaries of Arkansas Works, the state's Medicaid expansion program for low-income adults. Those people are now barred from Arkansas Works until Jan. 1.

That number is in addition to the 4,353 beneficiaries trimmed from (and subsequently locked out of) the Arkansas Works program in September, meaning the work requirement has cut insurance for about 8,500 Arkansans thus far. Back in June, when the requirement was put into place for the first subset of beneficiaries, the DHS estimated that about 69,000 people eventually would be required to report their work activity hours. The mandate has now eliminated over 12 percent of that initial number.

The Trump administration granted Arkansas permission to proceed with the experimental work rule in March, despite objections that it could lead to thousands being kicked off of their insurance. Arkansas is so far the only state to implement a work requirement; a similar program in Kentucky was blocked by a federal judge before it could get off the ground. A group of plaintiffs is suing to stop Arkansas's work requirement as well, but a decision in that suit is likely months away.

Because the new requirement is being phased in on a rolling basis, it is likely that coverage losses for November and December will be comparable to those in September and October. Beneficiaries are kicked off if they fail to report sufficient work hours for three months (consecutive or not) in a given calendar year. The 4,100 who just lost coverage were in their third month of noncompliance. The DHS report said another 4,841 were in their second month of noncompliance and 7,748 were in their first month.

Through a spokesperson, Hutchinson defended the work rule as good policy and said it had pushed thousands of Arkansans to find employment.

"There are plenty of jobs and training opportunities available in Arkansas, and the work requirement connects those who need training with the services and jobs currently available," he said in a statement sent by email.

"The 4,109 individuals who have not reported activities for the past three months under the common-sense work requirement have either found work, moved onto other insurance, moved out of state without notifying DHS, or chose not to comply," the governor said. "We have gone to great lengths to ensure that those who qualify for the program keep their coverage."

But advocates for the poor say the work requirement is making it harder for struggling individuals to find their footing and is causing needless suffering for people who rely on Medicaid-funded insurance.

Bernadette Reynolds, a board member of the Arkansas Homeless Coalition and co-pastor of Mercy Community Church in Little Rock, said she's worked with at least six people who have lost their insurance due to the requirement. None of them knew they'd been terminated until they tried to fill a prescription. Homeless individuals find it especially difficult to keep up with the reporting mandate, she said, including some who hold down a job while living on the streets.

"You’ve got to understand, a lot of our population have mental handicaps, so they can’t always keep appointments," Reynolds said. "Not everybody is high enough functioning to remember, 'Once a month I’ve got to report this … I've got to go online or get to the library or take time off of work.' Some of them just forget. And some of them don’t have a smartphone."

Because the homeless don't have a regular place to receive mail, they often miss correspondence from the DHS. "They can’t keep up with paperwork, because it gets rained on. People steal their bags. ... People lose their IDs, insurance cards, all their important papers, birth certificates. We’re forever in a cycle of trying to replace things so people can do what they need to do to survive," Reynolds said.

Jared Henderson, the Democrat challenging Hutchinson in next month's gubernatorial race, issued a statement condemning the work requirement's "disastrous consequences for Arkansas and our families." Henderson has labeled the policy an "internet requirement," since it forces beneficiaries to report their activities online.

"This negligent internet reporting policy jeopardizes our rural hospitals and their staff as thousands will be receiving uncompensated care after losing their health insurance," Henderson said.

Though Governor Hutchinson has championed the work requirement -- as well as other changes to Medicaid that have cut costs and suppressed enrollment -- he has also defended Medicaid expansion against fellow Republicans in the state legislature who have sought to end the program entirely. (He inherited the program from his Democratic predecessor, Mike Beebe.) Expanding Medicaid to cover low-income adults was a part of the Affordable Care Act, or Obamacare.

Independent of the losses directly attributable to the work requirement, the latest Medicaid enrollment numbers from the DHS show Arkansas Works is shrinking for other reasons as well. On Jan. 1, there were about 286,000 people enrolled in the program. On Oct. 1, there were about 253,000.

The decline may be due in part to a strong economy that has lifted some beneficiaries' income above the eligibility threshold for Medicaid expansion -- 138 percent of the federal poverty line -- but it may also be due in part to DHS policies that cancel people's insurance because of returned mail or failure to respond to minor paperwork. As the Arkansas Nonprofit News Network reported in August, Arkansas saw a larger percentage decrease in its Medicaid population over the past 18 months than any other state that expanded Medicaid.

State and national data show the majority of Arkansas Works recipients in the target population are likely working already. However, to fulfill the requirement, it is not enough to simply have a job. Beneficiaries must create an account through an online portal run by the DHS. They must then log on each month to report at least 80 hours of "work activities," which may include some portion of school, volunteering, job training or job search hours.

Critics complain that the process is confusing and the website is glitchy. Arkansas is ranked near the bottom of the nation in terms of internet access.

Only a tiny percentage of those subject to the work requirement actually reported their hours through the portal, the DHS report shows. The vast majority either claimed an exemption or else were automatically excluded by the DHS. Only about 1,500 people in September satisfied the reporting requirement -- and of those, over 1,000 did so by complying with a separate, preexisting work requirement in the SNAP program, or food stamps. That leaves just 500 people who reported work activities because of the new Medicaid work rule.

The requirement applies only to a portion of the Arkansas Works population. Arkansans ages 30-49 are subject to the requirement in 2018; people ages 19-29 will become subject to the rule beginning in 2019.

The majority of the approximately 253,000 beneficiaries on Arkansas Works as of Oct. 1 are exempt from the requirement, DHS data shows. Beneficiaries with a dependent child in the home are automatically exempt, as are full-time students and certain people deemed "medically frail." (Those in the larger "traditional" Medicaid program -- including children on ARKids, the elderly and people on federal disability -- are not subject to the work requirement.)

But that leaves tens of thousands who still must navigate the reporting process. Reynolds, the homeless advocate, said she's especially concerned for those with chronic conditions such as diabetes and hypertension. She's bracing for more coverage losses in the months ahead.

"I expect to see more people kicked off, and now we have winter and flu season coming up," Reynolds said.

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. It is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at

The Arkansas Nonprofit News Network is an independent, nonpartisan news organization dedicated to producing journalism that matters to Arkansans. Our work is re-published by partner newsrooms across the state.