Medicaid work rules coming nationwide, echoing Arkansas rollout
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Starting in 2027, federal law will require all states to do something that Arkansas tried seven years ago — requiring adult Medicaid recipients to work.
Why it matters: The main result in Arkansas in 2018 was that people lost health coverage.
- Andrew Hicks, a 37-year-old Little Rock resident who lost his health insurance over the old work requirement, worries it'll happen again and is already stockpiling medication, he told Axios.
Zoom in: Hicks now works for a small business that doesn't offer health insurance and says losing access to his antidepressant medication could be life-threatening.
- When he lost Medicaid under the Arkansas work requirements, he was a graduate student working for Uber and didn't meet the reporting requirements. Without medication, he didn't finish his master's program and was suicidal.
Flashback: In summer 2018, Arkansas implemented Arkansas Works, requiring some Medicaid recipients to document 80 hours of work or other qualifying activities each month or lose coverage.
- By the time a judge blocked the law the following spring, about 18,000 people had lost health insurance.
- A 2019 study conducted by the Harvard T.H. Chan School of Public Health found that Arkansas' work requirements did not lead to more employment or to more private health insurance coverage, at least not while the program was in effect.
State of play: New Medicaid changes require states to verify recipients' eligibility monthly and do redeterminations at least twice a year. The new law provides $200 million to states for implementation.
- The law includes some exceptions, such as for disabilities, pregnancy or caregiving.
What they're saying: Providing health insurance helps people be healthy enough to work, prevents emergency room visits and protects people from incurring medical debt or losing access to their medications, Camille Richoux, health policy director at nonprofit Arkansas Advocates for Children and Families, told Axios.
- "Medicaid is not a reward for having a job," she added.
The other side: "If you want to receive free health care paid for by your fellow taxpayer — able-bodied, working-age adults have to work, go to school, volunteer or be home to take care of their kids," Gov. Sarah Huckabee Sanders said earlier this year.
Reality check: Details of the submission requirements are not yet clear.
By the numbers: For fiscal year 2025, the Medicaid budget in Arkansas was about $9.68 billion, about $7.06 billion of which was federal money, state Department of Human Services spokesperson Gavin Lesnick told Axios in an email.
- As of August, 859,360 people in Arkansas were enrolled in Medicaid, according to DHS.
- About half of those are adults, including those enrolled in the Arkansas Health and Opportunity for Me (ARHOME) program that replaced Arkansas Works in 2022. The program uses Medicaid dollars to purchase private insurance and is for people ages 19-64.
What's next: Arkansas submitted a waiver dubbed Pathway to Prosperity in January before the federal legislation passed, asking the federal government to allow the state to implement requirements for Medicaid.
- The proposal is to use data-matching to identify people who weren't meeting the requirements and use personal development plans and success coaching to help keep them in compliance, rather than drop them permanently.
- The state is working with the Centers for Medicare and Medicaid Services (CMS) to ensure Pathway to Prosperity meets federal requirements and looks forward to implementing it as soon as possible, Lesnick said.