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Year End Review: December State Data for Medicaid Work Requirements in Arkansas

Arkansas is one of seven states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. CMS approved Arkansas’ waiver on March 5, 2018, and the new requirements took effect for the initial group of beneficiaries (those ages 30-49) on June 1, 2018. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work or exemption status by the 5th of the following month using an online portal; as of mid-December, they also may report by phone. A review of monthly data related to the new requirements released by the Arkansas Department of Human Services shows that from September through December 2018, over 18,000 people were disenrolled for failure to comply with the new requirements for three months. In January, enrollees who were disenrolled can regain coverage (if they reapply) and enrollees ages 19 to 29 will be subject to the requirements for the first time. Those who fail to comply with the requirements for three months could lose coverage in April 2019. This brief looks at data for December 2018. Separate reports look at early implementation of the new requirements and enrollee experiences.

Re-approval of Kentucky Medicaid Demonstration Waiver

On January 12, 2018, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 demonstration waiver in Kentucky, entitled “Kentucky Helping to Engage and Achieve Long Term Health” or KY HEALTH. On the same day that CMS approved Kentucky’s waiver, Governor Bevin issued an executive order directing the state to terminate the Medicaid expansion if a court decides that one or more of the waiver provisions are illegal and cannot be implemented. This fact sheet summarizes key provisions of Kentucky’s approved waiver.

Potential Changes to Medicaid Long-Term Care Spousal Impoverishment Rules: States’ Plans and Implications for Community Integration

Congress created the Medicaid spousal impoverishment rules to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility. Originally, states had the option to also apply the rules to home and community-based services (HCBS) waivers. Section 2404 of the Affordable Care Act (ACA), which is set to expire on December 31, 2018, changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally. This issue brief answers key questions about the spousal impoverishment rules, presents selected 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not extend Section 2404.

States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

Estimates of Eligibility for ACA Coverage among the Uninsured in 2016

Despite historic coverage gains under the Affordable Care Act (ACA), more than 27 million people in the United States remain without insurance coverage. Recent debate over the future of the ACA has led to uncertainty and confusion about whether and how ACA coverage will be maintained, but millions of currently uninsured people are eligible for ACA coverage under current law. This analysis provides national and state-by-state estimates of eligibility for ACA coverage options among those who remained uninsured.

How Might Older Nonelderly Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waivers?

Most of the states with approved or pending Section 1115 waivers that condition Medicaid eligibility on work would apply those requirements to all or most nonelderly adults (ages 19-64) who are not receiving Supplemental Security Income (SSI) cash assistance, including older nonelderly adults (ages 50-64). Older nonelderly adults may be limited in their ability to satisfy a work requirement due to barriers resulting from age and/or disability. Previous analysis shows that many nonelderly Medicaid adults (ages 19-64) have functional limitations that may interfere with their ability to work but do not rise to the stringent SSI level of disability, making them potentially subject to work requirements. Older nonelderly adults are over twice as likely to have a disability than younger adults (17% vs. 7%). Furthermore, older nonelderly adults account for nearly half (45%) of all nonelderly Medicaid adults with a disability but not SSI who could be affected by a work requirement. This analysis examines the implications of work requirements for Medicaid adults ages 50 to 64 (referred to as “older nonelderly Medicaid adults”) and provides national and state level estimates of their disability, SSI, and work status using data from the 2016 American Community Survey (ACS).

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.