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.
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This Medicaid waiver tracker page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. It includes resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.
Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and other eligibility restrictions. States are also likely to continue to pursue initiatives to address the opioid crisis, and the recent passage of bi-partisan legislation with new tools and financing could bolster these efforts. Primary areas of federal policy to watch in 2019 with implications for Medicaid include the expiration of temporary funding for Puerto Rico and the US Virgin Islands in the absence of legislative action as well as potential regulatory changes to public charge policies that would likely lead to Medicaid enrollment declines among immigrant families. Finally, reforms in benefits, payment and delivery systems continue to evolve as states and the federal government focus on managed care, social determinants of health, prescription drugs, and community based long-term care. While beyond the scope of this brief, Congress and states could also consider broader health reform that could expand the role of public programs in health care including Medicare for All or Medicaid buy-in programs that could have significant implications for Medicaid.
This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.
This brief presents perspectives of enrollees and safety net providers about Arkansas’ new Section 1115 Medicaid waiver work and reporting requirements based on focus groups and interviews. The discussions examine enrollees’ awareness of the new requirements and ability to set up online accounts for monthly reporting; the effect of the new requirements on enrollees’ work and common barriers to work; enrollees’ experience with monthly reporting; impacts on particular populations, such as those with disabilities or who are homeless; and the anticipated effects of coverage losses resulting from the new requirements.
On October 22, 2018, the Trump administration released new guidance on Section 1332 waivers established by the Affordable Care Act (ACA). The new guidance may encourage states to use 1332 waiver authority to make broader changes to insurance coverage for their residents, including to promote the sale of, and apply subsidies to, ACA non-compliant policies. On November 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released a discussion paper outlining a set of waiver concepts designed to provide states with a roadmap for developing waiver applications that use the flexibility granted under the new guidance. This issue brief describes the new guidance, highlighting key changes from the 2015 guidance, describes how state waiver activity may change, particularly in light of the waiver concepts put forward by CMS, and discusses possible implications of the changes.
Karen Pollitz answers three questions on the Trump administration’s recent changes to the ACA Section 1332 state innovation waiver guidelines and the implications for consumers and state marketplaces in our new “Ask KFF” feature.
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.
The Implementation of Work Requirements in Arkansas Has Been Complex and Many Medicaid Enrollees Are Not Aware of New Rules or Face Obstacles in Complying
The implementation of Medicaid work requirements in Arkansas has been complex, with many Medicaid enrollees still not aware of program changes despite substantial outreach. In addition, an online reporting requirement is proving difficult for many enrollees due to limited knowledge of the requirements as well as lack of computer literacy…
This brief analyzes the early experience with implementation of work and reporting requirements in Arkansas, based on publicly available data and information, as well as targeted interviews with state officials, health plans, providers, and beneficiary advocates conducted in August and September 2018.