February State Data for Medicaid Work Requirements in Arkansas
Issue Brief
CMS has also approved work requirement waivers in Arizona, Kentucky, Indiana, Michigan, New Hampshire, Ohio, and Wisconsin. CMS approved a work requirement in Maine, but Maine’s new governor rejected the waiver. Work requirement implementation began in Indiana in January, in New Hampshire in March, and is set to begin in Kentucky in July.
In 2018, the work requirement was phased in for those ages 30-49 with income at or below the federal poverty level. In January 2019, the work requirement also was applied to those ages 30-49 between 101% and 138% FPL.
On December 12, 2018, the state issued a press release indicating that enrollees would be able to report work activity by phone with DHS beginning on December 19.
According to state notices, coverage is terminated after the last day of the month (e.g., March 31st) if enrollees were not compliant in two earlier months and did not report 80 hours of qualifying activities by the last day of the month. However, individuals have until the 5th of the following month (e.g., April 5th) to report activities and could have coverage reinstated if they do so. Individuals who were disenrolled due to the work or reporting requirements in 2018 must file a new application to have coverage restored as of January 2019, and all enrollees subject to the new requirements have their non-compliance months reset to zero at the start of the new calendar year. For the next group of enrollees facing coverage loss due to any three months of non-compliance, notices will go out in March to those already non-compliant in two earlier months in 2019, informing recipients that their coverage will terminate as of April 1st but could be reinstated if they report 80 qualifying hours for March by April 5th.
On March 14, 2019, the U.S. District Court for the District of Columbia heard oral argument in a case brought by a group of Arkansas Medicaid enrollees challenging the U.S. Health and Human Services Secretary’s approval of Arkansas’s Section 1115 waiver including the work and reporting requirements. At the hearing, the judge indicated that he expected to issue a decision before April 1st. Gresham v. Azar, No. 1:18-cv-1900 (D.D.C.).
Of these 1,910 individuals, 1,889 regained coverage through Arkansas Works, meaning that they will again be subject to the work and reporting requirements, and 21 did so through other Medicaid eligibility pathways.
Another 22% of case closures were for unspecified “other” reasons.
The share of those not reporting in February (88%) was similar to the share not reporting in January (87%).
Of those 197 enrollees, 25 reported 80 or more hours of job search or job search training. Each month, however, enrollees are able to count only 39 hours of job search or job search training toward the required 80 hours of qualifying work activities, which means that those engaged in job search or job search training also must complete 41 hours of another qualifying activity or activities to meet the monthly requirement. One enrollee reported over 80 hours of health education classes, but enrollees are only able to count 20 hours of these classes per year. Seventy-five (75) of the 197 enrollees reported work that fell short of the 80-hour requirement in February, including 23 enrollees with at least 61 but fewer than 81 hours of work. Two enrollees reported education and training that fell short of the 80-hour requirement, including 2 with at least 61 but fewer than 81 hours. Nineteen enrollees reported volunteer hours that fell short of the 80-hour requirement, including 2 with at least 61 but fewer than 81 hours.
The state’s quarterly report for July 1, 2018 – September 30, 2018 has additional detail regarding reasons for good cause exemptions. Of the 140 good cause exemptions granted in September 2018, 31 were for failure to work and 109 were for failure to report. The majority of good cause exemptions for failure to work were for an enrollee with a disability (55%). Other reasons include family member disability (13%), hospitalization (13%), life-changing event (6.5%), technical issue (9.7%) or serious illness (3.2%). The large majority of good cause exemptions for failure to report were for technical issues (68%). Other reasons include enrollee disability (10%), hospitalization (6.4%), life-changing event (6.4%), family member disability (5.5%), serious illness (2.8%) and death of family member living in the home (1%). Ark. Dep’t of Human Servs. Ark. Works Program, Nov. 2018 Report (data as of Dec. 7, 2018, released Dec. 17, 2018), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ar/Health-Care-Independence-Program-Private-Option/ar-works-qtrly-rpt-jul-sep-2018.pdf
Other exemptions, accounting for about 7% of total exemptions, include pregnancy, caring for someone who is incapacitated, short-term incapacity, receiving unemployment benefits, receiving education and training full-time, participating in an alcohol or drug treatment program and American Indian / Alaska Natives. American Indian / Alaska Natives are subject to the requirements but will be phased in at a later date.
The same court also will decide whether HHS’s re-approval of Kentucky’s Section 1115 waiver exceeded the Secretary’s Section 1115 authority. Decisions in both cases are expected simultaneously. The Kentucky decision will address whether HHS has been able to successfully remedy the errors in the original Kentucky waiver approval. This issue bears on whether HHS might be able to similarly correct any errors in the original Arkansas waiver approval.