Arkansas Department of Human Services Sec. Kristi Putnam discusses the state’s waiver request for Medicaid work requirements on Jan. 28, 2025 as State Medicaid Director Janet Mann (left) and Gov. Sarah Huckabee Sanders listen. (Antoinette Grajeda/Arkansas Advocate)
State first implemented one in 2018 but was shut down by federal judge
By Antoinette Grajeda, Arkansas Advocate
Arkansas is again seeking a Medicaid work requirement that state officials say incorporates lessons learned from previous attempts.
Republican Gov. Sarah Huckabee Sanders on Tuesday shared a letter to U.S. Department of Health and Human Services Secretary-Designate, Robert F. Kennedy Jr. and a waiver request to the Centers for Medicare and Medicaid Services (CMS) requesting the implementation of a work requirement for “able-bodied, working-age recipients” of the state’s Medicaid expansion program — Arkansas Health and Opportunity for Me (ARHOME).
The waiver will be submitted to CMS following a 30-day public comment period, State Medicaid Director Janet Mann said.
Arkansas became the first state to implement a work requirement for some Medicaid recipients in 2018, but a federal judge halted the policy the following year. Arkansas was one of 13 states to receive permission to impose work rules on some Medicaid recipients during Donald Trump’s first administration. With his return to the White House, more states might again apply for work requirements from an administration that’s demonstrated it’s amenable to them, according to Stateline.
It costs Arkansas more than $2.2 billion annually to support the roughly 220,000 “able-bodied, working-age adults” on ARHOME, an estimated 90,000 of whom are unemployed, according to the letter. If the waiver is approved, the work requirement would apply to Arkansans ages 19-64 who are eligible through the new adult expansion group, have an income at or below 138% of the federal poverty level and are covered by a qualified health plan, according to the waiver request.
“The requirement is simple — you want to receive free health care paid for by your fellow taxpayer, able-bodied working-aged adults have to work, go to school, volunteer or be home to take care of their kids,” Sanders said at a press conference at the Capitol.
Learning from past issues with the program, state officials said the new waiver differs from previous work-requirement attempts in that it removes the burden of reporting requirements from recipients through the use of data matching. Data matching refers to the practice of comparing different sets of data to identify similarities and relationships.
Additionally, state agencies will use multiple forms of communication to connect with recipients, and when beneficiaries fall out of compliance, they will be suspended from the program instead of disenrolled, state officials said.
Medicaid eligibility was expanded during the COVID-19 pandemic, but when the public health emergency ended last year, the Arkansas Department of Human Services began “unwinding” the extension by disenrolling clients the agency considered ineligible.
Between April and September 2024, more than 184,500 Arkansans lost coverage because they did not provide necessary eligibility information. In some cases, beneficiaries likely declined to submit renewal paperwork because they no longer qualified for coverage, state officials have said. But advocates have argued that some still-eligible beneficiaries likely lost coverage because they never received proper notification or encountered problems when trying to return renewal information.
Arkansas Advocates for Children and Families said it was unable to comment on the details of the requested CMS waiver because DHS did not provide a copy prior to Tuesday’s announcement, but the nonprofit organization did have concerns about the waiver’s effect on Arkansas.
“Although the state is looking at the various problems that occurred during the last round of work-reporting requirements, the bottom line is that Medicaid is not a workforce or a work-incentive program,” AACF said in a statement. “It is an insurance program for low-income adults and children.”
Noting that 130,000 of the 220,000 able-bodied individuals on the program are currently working, AACF said this highlights that despite common messaging about Medicaid recipients, the majority have a desire to work and provide for their families.
During the state’s first attempt at a Medicaid work requirement, more than 18,000 Arkansans lost health insurance coverage between Sept. 1 and Dec. 31, 2018, for failing to meet those work-reporting requirements, according to AACF. Of those removed, 97% were compliant or had exemptions, but still lost coverage.
The loss of health care coverage can lead to higher health care costs for all Arkansans because of increased emergency room usage, hospitalizations and unreimbursed medical care, according to AACF.
“Hospitals could be impacted, and people will lose their jobs when they become too sick to work,” AACF’s statement reads. “At a time when families are living paycheck to paycheck and struggling with the high cost of living, now is not the time to take away people’s health insurance while forcing taxpayers to foot the bill for more unwanted bureaucracy.”
Work requirements are already part of other federal assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) program, DHS Secretary Kristi Putnam said Tuesday. The “Pathway to Prosperity” waiver is about helping Arkansans learn about new opportunities, seek new skills and pursue new careers, she said.
“The goal should be for Medicaid to be a safety net, and we should routinely see healthy adults moving from government dependence to economic independence, improving their health in the process,” Putnam said. “It is not punitive. It is about purpose.”
Individuals who are suspended from the program can become active again and have their full benefits restored by notifying DHS of their intention to cooperate with personal development plan requirements, according to the waiver request.
DHS also plans to use data matching to identify ARHOME beneficiaries who are “not on track towards meeting their personal health and economic goals,” according to the state’s waiver request. Those individuals will then be contacted by a “Success Coaching resource.”
DHS is assessing public and private options to fulfill Success Coaching roles, but intends to leverage resources and community partnerships, according to the waiver request.
Details about the nuances of the program’s implementation will be determined during negotiations with CMS, Putnam said.
The Arkansas Advocate is a nonprofit, nonpartisan news organization dedicated to tough, fair daily reporting and investigative journalism that holds public officials accountable and focuses on the relationship between the lives of Arkansans and public policy.
Have a news tip or event to promote? Email White River Now at news@whiterivernow.com. Be sure to like and follow us on Facebook and Twitter. And don’t forget to download the White River Now mobile app from the Google Play Store or the Apple App Store.
Get up-to-date local and regional news/weather every weekday morning and afternoon from the First Community Bank Newsroom on Arkansas 103.3 KWOZ. White River Now updates are also aired weekday mornings on 93 KZLE, Outlaw 106.5, and Your FM 99.5. And catch CBS News around the top of every hour on 1340 KBTA.
