Some Arkansas Medicaid recipients could, once again, be required to work to keep their health insurance coverage.
Gov. Sarah Huckabee Sanders on Tuesday said Arkansas would seek a waiver from the federal Centers for Medicare and Medicaid Services to allow the state to implement the work requirement. If approved, it would be the second time Arkansas imposed such a requirement for enrollees in the state’s Medicaid expansion program.
“My focus since the start of this administration has been to empower people, never trapping them in a life of poverty. We want to give Arkansans a hand up, not a handout, and giving everyone an opportunity to live their best life right here in Arkansas,” Sanders said in a news conference Tuesday.
Arkansas was the first state in the nation to implement a Medicaid work requirement under former Gov. Asa Hutchinson in 2018. The program suffered numerous setbacks, including problems with the online portal where recipients were required to submit their proof of work. As many as 18,000 Arkansans were kicked off of the Medicaid rolls in the 10-month span before the requirement was blocked in the courts.
Sanders attempted to revive the work requirement in 2023, but was blocked by the Biden Administration. She said the requirement would help foster a sense of personal responsibility, save Arkansans from “crime, fatherlessness and hunger,” all while helping to alleviate workforce issues.
“I go into factories and small businesses all over the state, and the number one complaint that we hear is that we can’t find people fast enough,” Sanders said. “My administration is investing into education and growing our workforce to help address that problem, but as long as we pay for people to sit on the sidelines, we will never reach our full potential.”
Sanders’ proposal would require all able-bodied adults aged 19 to 64 receiving healthcare under the state’s Medicaid expansion program – also called ARHOME – to work, go to school, volunteer or take care of their children at home. Sanders said as many as 90,000 of the state’s 220,000 able-bodied, working-age Medicaid expansion recipients have no job, though it’s unclear how many are full-time caretakers, volunteer or attend school.
“The goal should be for Medicaid to be a safety net, and we should routinely see healthy adults moving from government dependence to economic independence, improving their health in the process. It is not punitive. It is about purpose,” Arkansas Department of Human Services Secretary Kristi Putnam said, adding that work requirements already exist for recipients of the SNAP and TANF public assistance programs.
Arkansas Medicaid Director Janet Mann said DHS designed the waiver “taking into account lessons learned from previous work requirements.” She said the program will use a data-driven approach to track enrollees’ compliance.
“Working-age, non-disabled individuals covered by the Qualified Health Plans on ARHOME will be assessed ‘on track’ or ‘not on track’ through data matching and audits of automated activity tracking,” Mann said. “For those who are identified as ‘not on track,’ they will be provided the opportunity to receive focused care coordination services to support health and economic self-sufficiency.”
Mann said recipients will follow a “personal development plan,” and will receive coaching and care coordination services through existing community resources, including through the Division of Workforce Services, the Division of Career and Technical Education and local community partners.
Unlike the 2018 work requirement, Medicaid enrollees who don’t comply with the program will have their health insurance coverage suspended, as opposed to being disenrolled. Mann said healthcare benefits can be “rapidly restored” if the recipient gets back on track with their personal development plan, and said the program would not suffer from an “over-reliance on technology,” instead opting for personal communications through a variety of methods.
When asked about potential legal challenges to the program, Sanders said she was optimistic.
“It’s a new administration, one that we have a lot more confidence will work closely with us… the data matching component of this work requirement waiver request is different than what we’ve submitted in the past,” Sanders said, adding that suspending enrollees for non-compliance rather than disenrolling them would also bode well for the program if it faces legal challenges.
A statement from Arkansas Advocates for Children and Families said the nonprofit could not comment on details of the proposed waiver, as DHS did not provide a copy of the proposal prior to Tuesday's announcement. But, the statement said healthcare advocates have concerns about the requirement's potential negative effects.
"The numbers presented by Governor Sanders noted that 130,000 — more than half — of the able-bodied individuals on ARHOME are currently working. This highlights the fact that, despite what is often messaged about Medicaid recipients, the majority of individuals on Medicaid expansion have a desire to work and provide for their families.
"If the concern is the 90,000 able-bodied Arkansans who are not working, it would be beneficial to know how many of those meet the exemptions that DHS and the governor noted would be considered," the statement reads.
The statement also references coverage losses incurred under the state's 2018 work requirement, saying it could lead to higher healthcare costs for all Arkansans.
"When people lose their health insurance coverage, it raises health care costs for everyone because of increased ER usage, hospitalizations, and unreimbursed medical care. Hospitals could be impacted, and people will lose their jobs when they become too sick to work.
"At a time when families are living paycheck to paycheck and struggling with the high cost of living, now is not the time to take away people’s health insurance while forcing taxpayers to foot the bill for more unwanted bureaucracy."
The waiver request faces a 30-day public comment period before being submitted to the Centers for Medicare and Medicaid Services for approval.
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