Since the Trump Administration endorsed Medicaid work requirements on January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) has approved proposals from three states to waive federal law and implement so called “community engagement” programs into Medicaid. While work requirements in Kentucky and Indiana are troubling in their own right, Arkansas’ program sets a particularly dangerous precedent for disabled enrollees despite promises they would be exempt from work requirements. In Arkansas, some people with disabilities will have to prove, through a costly, duplicative and inaccessible process, that they qualify for an exemption—or face disenrollment from the Medicaid program.
Approved on March 4, 2018, Arkansas’ Medicaid program will require most enrollees to work or participate in work-related activities for at least 80 hours per month. The mandate applies to all people aged 19–49 who are enrolled in “Arkansas Works,” the Medicaid expansion program for adults with incomes up to 138 percent of the poverty line. Within this expansion population, 23 percent of enrollees (roughly 75,900 people) are disabled and will be subject to work requirements, unless they qualify for an exemption.
Arkansas’ work mandate claims to exempt people who cannot work. However, its exemption procedures are deeply flawed and will cause many disabled enrollees to lose their coverage in practice.Here are a few of the problems:
- In order to be exempt, enrollees will have to prove that they have a disability every two months. Arkansas will require each individual to not only submit an initial medical certification to “demonstrate” that they are “physically or mentally unfit for employment,” but they will also require each person to repeatedly prove—throughout the entire time they are enrolled in Medicaid—that they still cannot work. This will impose a heavy burden on disabled enrollees, who may have to make repeated, costly trips to the doctor’s office just to get the documentation they need to maintain their exemption. The details of how an enrollee will be required to re–verify their disability are still unclear, illustrating how ill–conceived these work exemptions really are.
- Exemption and work verifications will only be accepted electronically. Arkansas will require enrollees to submit their bimonthly exemption applications—or their monthly work reports, if working—via electronic means only. Thus, individuals without easy or secure access to the internet, and particularly low–income people with disabilities in rural areas, will be both disproportionately burdened to prove and at greater risk of failing to meet the requirements. Further, electronic verification can be an inaccessible format for many people with visual impairments or developmental disabilities. Because this is the only means by which a person can submit verifications, many people with disabilities will undoubtedly and unjustly lose their coverage.
- If an enrollee fails to comply with these procedures, they will lose their health care coverage and be “locked-out” for up to nine months. Individuals that fail to comply with Arkansas’ work requirements will be disenrolled from Medicaid and prohibited from re-enrolling until the following coverage year (a process that will presumably require a new application, but the details are unclear—again, highlighting the lack of thought that went into this mandate). These harsh penalties, when coupled with Arkansas’ burdensome and inaccessible procedures, will cause many disabled enrollees to be wrongfully denied access to health care.
For these reasons, DREDF strongly opposes CMS’ approval of Medicaid work requirements in Arkansas. As this ill-conceived decision proves, despite CMS’ repeated claims otherwise, work requirements will greatly impact people with disabilities. Clearly we also cannot count on CMS to ensure that Medicaid enrollees with disabilities are truly exempted from work requirements. In the coming months, states will continue to push the boundaries in Medicaid waivers. We must continue to push back.
For more information on Medicaid work requirements and their impact on people with disabilities, see the following resources:
- DREDF, eNews: Why Medicaid Work Requirements Hurt Disabled Americans and the Nation (Jan. 22, 2018).
- H. Stephen Kaye, Comm. Living Policy Ctr., How do disability and poor health impact proposed Medicaid work requirements? (Feb. 12, 2018).
- Ctr. on Budget & Policy Priorities, Arkansas’ Harsh Medicaid Work Requirement Jeopardizes Recent Progress (Mar. 5, 2018).
- Nat’l Health Law Program, HHS Approves Sec. 1115 Waiver in Arkansas: Effects on People with Disabilities (Mar. 8, 2018).