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 and internet access, according to a new analysis from KFF (the Kaiser Family Foundation).

Since Arkansas became the first state to implement Medicaid work requirements in June, more than 4,300 residents have lost coverage due to the work and reporting requirements and another 5,000 are at risk of losing their insurance should they fail to report for another month. Additional follow-up is needed to understand the circumstances leading to coverage loss.  The analysis of the state’s early experience with work and reporting requirements is based on publicly available data and information as well as interviews conducted in August and September with state officials, health plans, providers, and beneficiary advocates.

The analysis finds that telephone calls, emails, social media and online videos may have a limited reach as accurate phone numbers are often not available and enrollees may not have access to computers or internet.  Low literacy levels and the complexity of the process are also factors making outreach and education difficult.  Arkansas’ requirement that enrollees set up an online account and report work activities or exemptions monthly is a barrier for many enrollees who have low computer literacy and lack computers, email or internet access.  Interviewees noted additional obstacles to work such as transportation and lack of jobs for people with low educational levels.

The early experience in Arkansas can show other states considering similar policies the challenges and implications.  New Hampshire and Indiana have approved waivers for Medicaid work requirements, and 10 other states have waivers pending at the Centers for Medicare and Medicaid Services. A federal court blocked Kentucky’s Medicaid work requirements waiver and sent it back to the U.S. Department of Health and Human Services.

Monitor developments with our Medicaid waiver tracker. For more quantitative data on implementation of the new requirements in Arkansas, see An Early Look at State Data for Medicaid Work Requirements in Arkansas, released by KFF last month.