{"id":17104,"date":"2018-11-01T22:55:04","date_gmt":"2018-11-01T22:55:04","guid":{"rendered":"http:\/\/arknews.org\/?p=17104"},"modified":"2018-11-01T22:55:04","modified_gmt":"2018-11-01T22:55:04","slug":"as-medicaid-coverage-losses-mount-under-work-requirement-state-lacks-evaluation-plan","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2018\/11\/01\/as-medicaid-coverage-losses-mount-under-work-requirement-state-lacks-evaluation-plan\/","title":{"rendered":"As Medicaid coverage losses mount under work requirement, state lacks evaluation plan"},"content":{"rendered":"
\"\"
WAITING ON CMS: Led by Seema Verma.<\/figcaption><\/figure>\n

 <\/p>\n

Under the terms of its agreement with the federal government, Arkansas\u2019s work requirement for certain Medicaid beneficiaries requires the state to commission an independent evaluation to measure whether the policy is meeting its goals. But as of Nov. 1, the federal agency overseeing Medicaid has yet to approve an evaluation design. That means the state has not started searching for an evaluator \u2014 even though the work requirement has been up and running since June 1. <\/span><\/p>\n

In an email, Arkansas Department of Human Services spokeswoman Amy Webb said the state submitted a draft evaluation design to the federal Centers for Medicare and Medicaid Services (CMS) in May and revised it in August. \u201cSince it is still under review with CMS, an RFP has not been issued for the work and community engagement requirement. DHS is in the process of developing a procurement based on the proposed evaluation plan, pending final CMS final approval,\u201d Webb wrote. <\/span><\/p>\n

The DHS provided the Arkansas Nonprofit News Network with the draft evaluation design under a freedom of information request. Judy Solomon, a senior fellow at the progressive-leaning Center for Budget and Policy Priorities in Washington, D.C., said the draft appears to \u201cfall short\u201d in a number of ways. <\/span><\/p>\n

\u201cI\u2019m kind of not surprised that it hasn\u2019t been approved because, despite my disagreement with CMS [under] the Trump administration allowing these [work requirements], they do seem to at least have some seriousness about \u2026 having evaluations that make sense,\u201d Solomon said.<\/span><\/p>\n

Arkansas\u2019s first-of-its-kind work rule requires certain beneficiaries ages 19 to 49 who are on Arkansas Works, the state\u2019s Medicaid expansion program for low-income adults, to report 80 hours of work activities each month, report an exemption or lose their insurance. The DHS terminated coverage for approximately 8,500 nonelderly adults in September and October who were noncompliant for three months. That doesn\u2019t necessarily mean those 8,500 people weren\u2019t working \u2014 just that they didn\u2019t report their work hours to the DHS through an online portal. Both DHS data and independent research show the majority of Medicaid expansion beneficiaries are already working.<\/span><\/p>\n

If a beneficiary\u2019s coverage is terminated, he or she is locked out of Arkansas Works for the rest of the calendar year.<\/span><\/p>\n

The work requirement has sparked vigorous debate. Are people who have lost their insurance finding coverage elsewhere \u2014 such as with an employer \u2014 or are they simply remaining uninsured? Does a work requirement incentivize employment and lead to better health outcomes or does it arbitrarily punish the poor and make them less healthy?<\/span><\/p>\n

Such questions are more than academic because the policy is by definition an experiment. It was created under a type of federal waiver issued by CMS \u2014 known as a Section 1115 demonstration \u2014 that is intended to foster state-level innovations in Medicaid. The terms and conditions attached to the waiver amendment creating the work requirement say Arkansas must contract with an independent entity to evaluate the program. <\/span><\/p>\n

Although work requirements are sometimes attached to programs such as welfare or food stamps, no other state has imposed such a rule on Medicaid coverage. (A work requirement in Kentucky was blocked by a federal judge earlier this year, and a group of plaintiffs in Arkansas have filed suit on similar grounds.)<\/span><\/p>\n

On March 5, CMS Director Seema Verma granted Arkansas its requested waiver amendment. The federal agency told Arkansas DHS Director Cindy Gillespie in a letter that DHS must \u201ctest whether coupling the requirement for certain beneficiaries to engage in and report work or other community engagement activities with meaningful incentives to encourage compliance will lead to improved health outcomes and greater independence.\u201d In its rationale for allowing Arkansas to proceed with the work requirement, CMS said the program was \u201clikely to assist in improving health outcomes\u201d because employment is \u201ccorrelated with improved health and wellness.\u201d<\/span><\/p>\n

But the draft evaluation design that Arkansas DHS submitted to CMS did not propose testing the hypothesis that the policy would improve health outcomes. Instead, it says, the evaluation will address \u201cthree core questions\u201d: Whether or not work requirements \u201cpromote personal responsibility and work,\u201d \u201cencourage movement up the economic ladder\u201d and \u201cfacilitate transitions\u201d from Medicaid to other types of insurance. <\/span><\/p>\n

The work requirement will \u201cresemble an income security program\u201d and should be evaluated as such, the draft says. Its RFP will be limited to bidders who \u201chave demonstrated experience in evaluating the impact of work requirements on participation in income security programs.\u201d<\/span><\/p>\n

Solomon said Arkansas\u2019s draft \u201c[doesn\u2019t] even raise the question of, \u2018Well, maybe if we\u2019re taking coverage away from people, it\u2019s going to make them less able to work, or it\u2019s going to make them less healthy.\u2019 \u2026 Why are they looking at this like it\u2019s not a health program?\u201d<\/span><\/p>\n

Asked by email why health outcomes were not the focus of the DHS\u2019 proposed experimental design, Webb responded by email. \u201cIt is widely recognized that employment improves an individual\u2019s health: Work has a positive influence on an individual\u2019s health and security; Returning to work has significant health benefits, especially mental health benefits. \u2026 People who work live longer and healthier lives,\u201d she wrote.<\/span><\/p>\n

She also said the evaluation would survey former beneficiaries who lost coverage and remained uninsured. \u201cThe survey will include relevant questions from the National Health Insurance Survey such as an individual\u2019s regular source of care, whether an individual did not receive care because of an inability to pay, and their self-evaluation of their health condition, etc,\u201d Webb wrote. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

  Under the terms of its agreement with the federal government, Arkansas\u2019s work requirement for certain Medicaid beneficiaries requires the state to commission an independent evaluation to measure whether the policy is meeting its goals. But as of Nov. 1, the federal agency overseeing Medicaid has yet to approve an evaluation design. That means the […]<\/p>\n","protected":false},"author":2,"featured_media":17105,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-17104","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care"],"yoast_head":"\nAs Medicaid coverage losses mount under work requirement, state lacks evaluation plan - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2018\/11\/01\/as-medicaid-coverage-losses-mount-under-work-requirement-state-lacks-evaluation-plan\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"As Medicaid coverage losses mount under work requirement, state lacks evaluation plan - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"  Under the terms of its agreement with the federal government, Arkansas\u2019s work requirement for certain Medicaid beneficiaries requires the state to commission an independent evaluation to measure whether the policy is meeting its goals. 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