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Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018

Issue Brief
  1. U.S. Census Bureau, How Disability Data are Collected from the American Community Survey, (Oct. 17, 2017), https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html.

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  2. SSI beneficiaries have an impaired ability to work at a substantial gainful level as a result of old age or significant disability.

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  3. The maximum SSI benefit is 74% of the federal poverty level (FPL, $9,252/year for an individual in 2019), and the asset limit for an individual is $2,000. The ACA Medicaid expansion covers individuals up to 138% FPL ($17,236/year for an individual in 2019) without an asset test in states that opt to adopt it. States also have the option to extend financial eligibility for disability-related Medicaid coverage pathways up to 300% of SSI ($27,756/year for an individual in 2019).

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  4. People who qualify for Medicaid both as an expansion adult and based on a disability can choose the group through which they enroll in coverage; benefit packages may differ by coverage group.  42 C.F.R. § 435.911 (c) (2), (d).

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  5. 42 C.F.R. § 440.315 (f).

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  6. Kaiser Family Foundation, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey (June 2019).

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  7. CMS Special Terms and Conditions, Arkansas Works, No. 11-W-00287/6 (approval period March 5, 2018 through Dec. 31, 2021, amended March 5, 2018), at p. 14, 23 (f) regarding Arkansas Works Premium Assistance Enrollment Notices (providing that the “notice will include information describing how Arkansas Works beneficiaries who believe they are medically frail can request a determination of whether they are exempt from the ABP. The notice will also include alternative benefit plan options.”), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-works-ca.pdf.

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  8. Enrollees who were subject to the work and reporting requirements were sent a notice the month before, indicating when their work requirement began and that, unless they received another notice saying that they were exempt from reporting, they had to report their work activities by the fifth of the following month or would be considered non-compliant and would lose coverage after three months of non-compliance. AR Works Information, Notices and Flyer Samples, Example – Subject to Work Requirement – Work Activities, last accessed Oct. 5, 2018, on file with author.

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  9. CMS Special Terms and Conditions, Arkansas Works, No. 11-W-00287/6 (approval period March 5, 2018 through Dec. 31, 2021, amended March 5, 2018), at p. 21-22, 53, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-works-ca.pdf; see also Ark. Medical Servs. Pol’y Manual, Section F-201, Good Cause Exemptions (May 1, 2018).

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  10. Ark. Dep’t of Human Servs., Ark. Works Section 1115 Demonstration Waiver Annual Report, Jan. 1, 2018-Dec. 31, 2018 (posted by CMS, April 9, 2019), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf.

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  11. CMS Special Terms and Conditions, Arkansas Works, No. 11-W-00287/6 (approval period March 5, 2018 through Dec. 31, 2021, amended March 5, 2018), at p. 20-21, 51-52, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-works-ca.pdf.

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  12. AR Works Information, Notices and Flyer Samples, Example – Subject to Work Requirement – Work Activities, last accessed Oct. 5, 2018, on file with author.

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  13. CMS Special Terms and Conditions, Arkansas Works, No. 11-W-00287/6 (approval period March 5, 2018 through Dec. 31, 2021, amended March 5, 2018), at p. 20-21, 52, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/ar-works-ca.pdf.

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  14. Ark. Dep’t of Human Servs., Ark. Works Section 1115 Demonstration Waiver Annual Report, Jan. 1, 2018-Dec. 31, 2018 (posted by CMS, April 9, 2019), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-annl-rpt-jan-dec-2018.pdf.

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  15. U.S. Dep’t of Health & Human Servs., Budget in Brief, Putting America’s Health First, FY 2020 President’s Budget for HHS, at p. 100, https://www.hhs.gov/sites/default/files/fy-2020-budget-in-brief.pdf.

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