Medicaid work requirements aren’t boosting employment in Arkansas

Arkansas, the first state to implement work requirements for certain Medicaid beneficiaries, isn’t seeing the promised benefit of increased employment as a result of the new rules, according to a recent report from The Commonwealth Fund.

The requirements, which mandate that certain beneficiaries report 80 hours of work or work-related activities to the state monthly to maintain their health insurance coverage, are allowed under the Trump administration after it made changes in 2018. Arkansas is among a handful of states that have implemented such programs under the guise of boosting employment. The state implemented the program in June 2018, and it was immediately clear that thousands of people would lose their health benefits.

However, the numbers are clearer thanks to the Commonwealth Fund’s research. Between October and December 2018, 17,000 adults were removed from the state’s Medicaid program after the work requirements were in place, the report found.

The findings were published in the New England Journal of Medicine, with researchers led by Benjamin Sommers, MD, of the Harvard T.H. Chan School of Public Health, looking at how employment and insurance coverage changed in the state in the aftermath of the work requirements. Researchers specifically compared 30-to-49-year-olds who were subject to the work requirements, as well as other age groups, who were to subject to the rules.

Medicaid or marketplace coverage in the state among the 30-49-year-olds fell 6.8 percentage points from 2016 to 2018, while the uninsured rate among this group increased from 10.5% in 2016 to 14.5% in 2018. Other age groups showed similar trends, albeit smaller changes, the study found.

While fewer people were insured in Arkansas over time, employment did not see an increase. Employment actually declined from 2017 to 2018, from 42.4% to 38.9% among 30-to-49-year-olds. Other age groups saw similar declines. In addition, hours worked in the state saw no significant changes over that time.

“The first six months of Arkansas’s work requirements resulted in a significant loss of Medicaid coverage and a significant rise in uninsured rates, indicating that many people who lost Medicaid coverage did not obtain other health coverage,” the report reads. “Researchers found no significant changes in employment associated with the work requirements.” 

Many of the people targeted by the work requirements already met work hours or should have been exempt, according to the Commonwealth Fund.

One of the biggest criticisms of state work requirements for Medicaid is that many beneficiaries aren’t aware of the policy changes or are confused about their reporting requirements. About half of the target population in Arkansas were unsure if the new requirements applied to them, according to the study. The program kicks people off Medicaid if they fail to report work hours for three months during a year.

As more states put in requests for similar programs, allowing work requirements continues to be a battle for the Trump administration, after some states faced lawsuits as a result of the implementation.