As the legislatures and governors in the states that expanded Medicaid this election—Idaho, Nebraska, and Utah—start to look at how to implement the program, they'll likely be tempted to follow the Arkansas model of adding in work requirements. They shouldn't. In just the three months since Arkansas's work requirements waiver was approved by the Trump administration and implemented, more than 12,000 people have lost coverage, with another 6,000 possible by the end of this month.
Under their waiver, non-elderly, non-disabled people have to report their employment and must work 80 hours per month. If they don't meet that requirement for three months in a calendar year, they lose coverage. At least nine of those former enrollees are suing the state as plaintiffs in a federal suit challenging the provision brought by the National Health Law Program, the Southern Poverty Law Center and Jonesboro-based Legal Aid of Arkansas.
The suit charges that the Trump administration exceeded its authority under the Medicaid statute in approving the work requirement waiver, but also that the state is unlawfully requiring enrollees report their hours solely online. The Affordable Care Act requires that states allow enrollments online, in person and by mail or telephone. Arkansas ranks 48th in the nation for internet access. Thirty percent of the population has just one internet provider, and about 20 percent of people there only have a smart phone for internet access at home. With 17 percent of the residents living below the poverty line, many don't have that access at all, and that includes the Medicaid population, working and not. It's not clear right now what percentage of the people who've lost coverage actually do meet those work requirements, but don't have the capacity to report their hours.
To make matters more troublesome, even the Trump administration hasn't entirely signed off on this program. The state was supposed to demonstrate to the administration that the program is working. It is required to commission an independent analysis to evaluate the effectiveness of the program, but so far hasn't even started to look for that evaluator because it hasn't designed an evaluation tool that the administration will sign off on. They got a "do over" instruction from the Centers for Medicare and Medicaid Services (CMS) on November 1, telling the state its proposed evaluation design "should be better articulated and strengthened." Seriously, the Trump administration flunked their first draft, that's how bad it was.
Even one of the administration's harshest critics, Judy Solomon at the Center for Budget and Policy Priorities in Washington, D.C., said that "I'm kind of not surprised that it hasn’t been approved, because despite my disagreement with CMS [under] the Trump administration allowing these [work requirements], they do seem to at least have some seriousness about … having evaluations that make sense." When Trump's CMS is more serious than Arkansas, you know the state has a big problem.