Arkansas is at the forefront of a national experiment to see whether requiring work for health care coverage helps lift people out of poverty.
Starting next month, many who are on the state’s low-income health care program, Arkansas Works, must show they are working, volunteering, in school, or getting job training for at least 80 hours each month. The Arkansas Department of Human Services estimates 42,000 Arkansans will be impacted.
Gov. Asa Hutchinson says the goal is to get beneficiaries prepared to work.
“A work requirement will give people responsibility to, if they’re underemployed or if they don’t have sufficient training, to go over to our Department of Workforce Services, get evaluated, get referred for more training, for a better paying job. That’s the goal,” he said.
The state has seen the second highest jump in its insured population of all states nationwide since it expanded Medicaid through the Affordable Care Act according to polling done by Gallup. Some healthcare advocates who lauded the expanded coverage, like Marquita Little at Arkansas Advocates for Children and Families, say the plan to implement work requirements is misguided.
She says the changes are a barrier to getting health care for low-income people. For example, under the new rules, if someone misses a few months of work they can be kicked out of the program for the remainder of the calendar year.
Little says even the people who can claim exemptions for the work requirements, like parents and people who have severe medical issues, will have to do new paperwork to prove their difficult circumstances.
“The problem is going to be the complexity of actually navigating this system [for beneficiaries],” she says. “[It will] open the door for all types of complications and difficulties."
Brad Holloway is the director of Little Rock’s Community Mental Health Clinic. He says keeping their patients enrolled in existing public healthcare programs is already so complex his office spends much of its time just helping patients keep up.
“We’ll get notification that they lost their Medicaid, or it’s this or that, their SSI, or they made too much money. One of the main things we do every day is make sure we can help them and guide them to keep the benefits that they have.”
The Department of Human Services will be responsible for helping people in the program figure out the new rules. The department estimates the program will cost $7.5 million to implement.
For Joe Thompson who directs the Arkansas Center for Health Improvement, a health policy think tank that's part of the University of Arkansas for Medical Sciences, the program is designed to offer flexibility to enrollees.
“I think from my vantage point, Arkansas has done a stellar job at putting in place things they could think of, likely to help individuals navigate the new requirements,” he said.
He added that he believes insurance companies will step in to help their low-income customers figure out what they need to do to document their work or their exemptions from the rule.
But to Marquita Little, the whole premise of making people work for healthcare assumes that people aren’t working who could be.
“I think it’s just based on that false narrative that people live in poverty because they choose to,” she said.
This is the first time the federal government has allowed states to make work mandatory for Medicaid. Arkansas will be the first state to do so. Thompson says it’s the beginning of a national experiment and conversation about whether making low-income people work helps them or hurts them.
“There is national dialogue about what should be expected of individuals” in this circumstance.
Arkansas has a five-year federal waiver to test the work requirements. As part of that, the state will have to measure the impacts of the change, whether it helped people find work or prevented them from seeing the doctor.
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