Arkansas Gov. Asa Hutchinson On Medicaid Work Requirement

Mar 29, 2019
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RACHEL MARTIN, HOST:

Should some Medicaid recipients be required to work to get coverage? Some Republican leaders say yes, that the requirement encourages those who can work to find it. But this week, a federal judge said no. That means that Arkansas and Kentucky, two states that want to implement Medicaid work requirements - and in Arkansas, did - they have to stop or at least pause.

That's a relief for people like Leland Moore (ph). He says he's a Medicaid recipient in Arkansas whose benefits were in jeopardy because of the work requirement.

LELAND MOORE: I was required to work to keep my insurance - even though I was basically unable to work.

MARTIN: Moore is a former factory worker and says he hasn't been able to work for seven years.

MOORE: I have arthrosis, asthma, spina bifida, acute exasperation (ph) COPD. When I was 41, I had a hip implant from arthrosis. I'm on 10 different medications.

MARTIN: Asa Hutchinson is the governor of Arkansas. He is a Republican, and he has urged the Trump administration to appeal this week's ruling. And he joins us now.

Governor, thank you so much for being here.

ASA HUTCHINSON: I am glad to be with you today.

MARTIN: The judge in this case said your state's work requirements undermine the very purpose of Medicaid, which is to give medical care to low-income people. What's your response to that?

HUTCHINSON: Well, the judge's ruling did away with our work requirement. And it's called a work requirement, but it's also called a community engagement, which requires somebody who is able-bodied to either work or to seek a job or to be in training or, if a job is unavailable, to volunteer for some community organization for 20 hours and to report that. That was the essence of our work requirement. The judge struck it down. And the gentleman who was on the program before me - sounds like he would qualify to be medically frail, which would be exempt from the work requirement automatically. And so...

MARTIN: He says he was kicked off the rolls and had to work through Legal Aid in order to restore his Medicaid benefits. I mean, is there a problem with the reporting process, which many people have said is really onerous? So even if you'd qualify for a medical exemption, it's really hard to do that.

HUTCHINSON: It could be. It could be that his issue was that he simply failed to report or to identify himself as medically frail. And so the judge did not reach, in his decision, the issue of whether the reporting required - requirement was too onerous or not. And of course, to report your work, you can use a telephone, you can do it in person, you can do it by online portal - many different ways. And we try to provide as much assistance as possible for those to have the help that they needed to comply with that reporting requirement.

He didn't even reach the reporting requirement because the judge fundamentally disagreed that any aspect of Medicaid cannot include any work requirement that might result in someone losing coverage. Well...

MARTIN: So why do you think that's wrong? I mean, why do you think this work requirement is necessary for someone who is already hurting because life has thrown a bunch of stuff at them and the only way they can get coverage is through Medicaid? So they're already struggling, and then this makes it harder for them.

HUTCHINSON: Well, again, these are able-bodied individuals that we're speaking of. That's part of the criteria. This is not the Medicaid for the disabled that we're speaking of a work requirement. It is - this is the expanded Medicaid. And the whole purpose of the Affordable Care Act and the expanded Medicaid was to help people get to work. So work is a fundamental part of that expanded Medicaid program. The judge based his decision on the original Medicaid Act, that the purpose is all health care and there's not any responsibility that goes with it. It is...

MARTIN: Although we should just point out, the Medicaid expansion in Obamacare did not include a work requirement.

HUTCHINSON: That's true. That's why we have a waiver, which is a demonstration project, and permission to see how this works in a state like Arkansas. We asked for flexibility to implement the program. And the judge says you have no flexibility. The judge says it's an entitlement program that you cannot put additional requirements on that might lead to a loss of coverage. So what that means for us is that we have to go back to a voluntary referral with no consequence to it, which is what our previous waiver was.

And here in Arkansas, because we had it mandatory and there was a consequence to losing it, we moved over 11,000 - actually, over 12,000 people from dependency into work where they had employment and they were able to move off of coverage. That is what our goal is - is not to - we want them to have the health care coverage. We want them and we help them to comply. But we also want to help them to get to work and to show them where the path is so that they can have an income. Now, this is...

MARTIN: Let me ask - sorry to interrupt you. Just with seconds remaining - what does happen now? I mean, first of all, with any appeal, and secondly, with the people who were kicked off rolls because of the work requirement. Can they get back on now during this stay?

HUTCHINSON: Absolutely. Well, first of all, they could have got back on even before the judge's ruling because under our Medicaid work requirement program, you had a - if you failed to comply, you lost your coverage last year, but you can re-enroll this year. Eighteen thousand lost their coverage last year. Only 2,000 have re-enrolled this year, but all of them can re-enroll.

Now with the judge's decision - of course, we're not going to be removing anybody from the roll; the judge has prohibited us from doing that. We are going to appeal the decision because we believe in the fundamental principle of a work requirement, a community engagement requirement. And we're going to ask a higher court to review that and ask the Justice Department to handle that.

MARTIN: Governor Asa Hutchinson of Arkansas.

Governor, thank you very much for your time.

HUTCHINSON: Great to be with you. Transcript provided by NPR, Copyright NPR.