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Arkansas’ Experience with Work Reporting Requirements: A Cautionary Tale

Arkansas’ work reporting requirement is similar to Virginia’s in that both states will take coverage away from people for not meeting a minimum monthly threshold of 80 hours of work or qualifying activities such as community service, attending school, or searching for work. In addition, both states will take coverage away from people if they are unable to successfully report these activities or qualify for exemptions for three months. By the end of December 2018 — only 7 months after implementation — more than 18,000 people had lost health coverage through Arkansas’ Medicaid program — over 23% of the entire Medicaid expansion population subject to the requirement.1 It’s important to note that this all occurred to only a portion of Arkansas’ Medicaid population — enrollees aged 30 to 49 earning at or below the federal poverty level — as part of a phase-in process.2 Even higher numbers of coverage loss would likely have occurred if it were not for a court decision that put a halt on the full implementation of a work reporting requirement in Arkansas.

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The majority of people who lost coverage in Arkansas are likely those who were meeting the hourly work requirement guidelines or should have been exempt. Almost half (44%) of people in Arkansas who could be subject to the policy — based on age and income — were unsure whether the requirement did or could apply to them, according to a study in the New England Journal of Medicine.3 The study also found that nearly 96% of the same population that could be subject to the policies appeared to be meeting the requirement or qualify for an exemption.4 Based on these findings, we would expect to see just 4% of the population lose coverage, instead losses were more than 5 times larger.

Finally, the Arkansas work reporting requirement did not lead to any notable increase in job attainment. Of the 18,164 people in Arkansas who lost coverage in 2018 for not reporting required activities on a monthly basis, only 1,981 had matches in the state’s New Hire Database.5 That means that for the more than 16,000 others who lost coverage, there is no evidence that they found new work. This is likely because they were already working. In fact, nationwide the majority of people between the ages of 19 and 64 who are enrolled in Medicaid (and who are not dually enrolled in Medicare and do not receive Supplemental Security Income) are working, according to a Kaiser Family Foundation study.6

The work reporting requirement actually had little to no impact on employment rates, according to a New England Journal of Medicine study. The study shows that employment rates slightly declined for all populations studied including those who could be subject to a work reporting requirement in Arkansas.7 The employment rate went down 3.5 percentage points for Arkansans 30 to 49 years of age who are eligible for Medicaid based on income while other comparison populations studied had decreases ranging from 2.9 to 5.7 percentage points.8 Mandating a work reporting requirement for Medicaid coverage does not help people maintain or secure employment.

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  1. Wagner, J., “Commentary: As Predicted, Arkansas’ Medicaid Waiver Is Taking Coverage Away From Eligible People,” CBPP, Jun 2019
  2. Greene, J., “Early Lessons From Arkansas And Indiana’s Very Different Medicaid Work Requirement Policies And Implementations,” Health Affairs, Mar 2019
  3. Sommers, B., Goldman, A., Blendon, R., et al., “Medicaid Work Requirements — Results from the First Year in Arkansas,” The New England Journal of Medicine, Jun 2019
  4. Ibid.
  5. Garfield, R., Rudowitz, R., Orgera, K., Damico, A., “Understanding the Intersection of Medicaid and Work: What Does the Data Say?,” Kaiser Family Foundation, Aug 2019
  6. Sommers, B., Goldman, A., Blendon, R., et al., “Medicaid Work Requirements — Results from the First Year in Arkansas,” The New England Journal of Medicine, Jun 2019
  7. Ibid.
Freddy Mejia

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