Work requirement approved for Arkansas' Medicaid expansion

The Trump administration on Monday approved Arkansas' plan to require thousands of people on its Medicaid expansion program to work or volunteer, making Arkansas the third state allowed to impose such restrictions on health care coverage for the poor.

Gov. Asa Hutchinson announced that the requirement for Arkansas' program, which uses Medicaid funds to purchase private insurance for low-income residents, had been approved by the Centers for Medicare and Medicaid Services. More than 285,000 people are on the Arkansas program, which was created as an alternative to expanding traditional Medicaid under the federal health law.

"This is not about punishing anyone," the Republican governor said at a news conference with Seema Verma, who heads the Centers for Medicare and Medicaid Services. "It's about giving people an opportunity to work. It's to give them the training that they need. It's to help them to move out of poverty and up the economic ladder."

The Trump administration in January said it would allow states to impose work requirements on Medicaid recipients. It has already approved proposals from Kentucky and Indiana.

The new requirement will eventually affect non-disabled, childless adults on the plan who are 19 to 49 years old. This year, the change will affect about 39,000 people aged 30 to 49 years old, though it wasn't immediately clear how many people will be affected next year, when the requirement is imposed on participants aged 19 to 29 years old, according to the state Department of Human Services.

People affected by the change will be required to work or participate in other activities such as volunteering or vocational training for 20 hours a week.

Arkansas' proposal will not affect people on its traditional Medicaid program, which covers about more than 645,000 people statewide.

Several other states have requests for work requirements pending with the Trump administration. Critics of the policy have called it unnecessary and say it could lead to people losing coverage, even if they meet the requirements.

"We don't think that it will be any more effective than if we had just offered Arkansans the necessary support they need to overcome barriers to employment without punitive measures," said Marquita Little, health policy director for Arkansas Advocates for Children and Families.

The work requirement's approval was seen as key to winning support for reauthorizing the Medicaid expansion by state lawmakers in Arkansas. The state budget bill for Medicaid and the expansion require three-fourths support in both chambers of the Legislature, and vacancies in the Arkansas Senate have left supporters shy of the votes they'll need.

"I think it will help and it will get us closer, but whether or not it pushes us over the edge we probably won't know until the vote is cast," Senate Majority Leader Jim Hendren said.

Verma, however, didn't approve another proposal by Arkansas to move 60,000 people off the Medicaid expansion by lowering the eligibility cap from 138 percent of the federal poverty level to 100 percent. The federal poverty line this year is $12,140 for a single person or $25,100 for a family of four. Verma and Hutchinson said they would continue to discuss that proposal.

Arkansas would have been the first state to scale back the eligibility for a key part of the federal health overhaul. The people affected would have been eligible to buy subsidized private insurance through, the federally run health care insurance exchange.


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