Revoke work rule for state Medicaid, 2 lawmakers urge

Oregon, N.J. Democrats send letter to U.S. official, decry coverage losses

Gov. Asa Hutchinson displays a 2013 release documenting a previous record for a low Medicaid growth rate during a news conference Friday at which he touted his administration’s efforts to control the growth of Medicaid.
Gov. Asa Hutchinson displays a 2013 release documenting a previous record for a low Medicaid growth rate during a news conference Friday at which he touted his administration’s efforts to control the growth of Medicaid.

Citing the more than 18,000 Arkansans who have lost coverage as a result of the work requirement for the state's Medicaid program, two congressional Democrats have called on Health and Human Services Secretary Alex Azar to rescind his approval of such requirements in Arkansas and other states.

"In our letter to you from August of last year, we expressed our deep concern that Medicaid 1115 waiver demonstrations that adopt restrictive conditions on eligibility like work requirements threaten to impede access to critical care for millions of Americans," Sen. Ron Wyden of Oregon and Rep. Frank Pallone Jr. of New Jersey wrote in a letter this week to Azar, referring to a section of the Social Security Act.

"We unfortunately are now seeing these concerns play out in real life in the state of Arkansas where thousands of individuals have been forced out or locked out of their Medicaid coverage."

Wyden and Pallone cited a Feb. 6 Los Angeles Times article reporting that Arkansas and the seven other states that had been approved to implement work requirements did not have plans in place to track how many recipients find jobs or improve their health.

The newspaper also reported that nine of the 17 states that had sought approval to implement work requirements did not provide estimates of how many recipients would lose coverage.

"The Administration's complete disregard for adhering to robust tracking and evaluation requirements in the case of these harmful waivers is further evidence that taking health coverage away from people is not in any way a legitimate experiment, especially one that achieves the statutory goals of the program to provide medical assistance," the Congress members wrote in their letter, dated Tuesday and made public Thursday.

Wyden is the ranking member of the Senate Committee on Finance; Pallone is chairman of the House Committee on Energy and Commerce.

The U.S. Centers for Medicare and Medicaid Services on Nov. 1 rejected a draft evaluation plan submitted by Arkansas, citing deficiencies such as inadequately defined expected outcomes and a lack of detail on the data sources that would be used.

Arkansas Department of Human Services spokesman Amy Webb said this week that the department was still working with the federal agency on the plan.

At Politico's State Solutions Conference in Washington, D.C., on Friday, Gov. Asa Hutchinson defended the work requirement.

"If you don't have some consequences for irresponsible action, then it is a meaningless program," Modern Healthcare quoted the governor as saying.

Hutchinson spokesman J.R. Davis added in a phone interview that the results of the requirement show the opposite of what Wyden and Pallone contend.

He noted that, after Jan. 1, the 18,164 Arkansans who lost coverage for their noncompliance in 2018 became eligible to re-enroll, but that only about 1,400 had done so by the end of January.

The low rate of re-enrollment supports Hutchinson's contention that many enrollees had moved out of state or obtained coverage from another source, such as a spouse's job, he said.

Davis added that as of Wednesday, 9,261 Arkansans subject to the work requirement had started new jobs.

"It's very clear that it's working," he said.

Advocates for low-income residents have argued that many who lost coverage may not be aware they are eligible to re-enroll or have been discouraged by difficulties complying with the requirement.

Arkansas in June became the first state to implement a work requirement for some of its Medicaid recipients.

To stay in compliance, the recipients must spend 80 hours a month on work or other approved activities, unless they qualify for an exemption, and report their activities over the phone or through a state website.

The requirement applies only to enrollees in Arkansas Works, which covers people who became eligible for Medicaid when the state extended coverage in 2014 to adults with household incomes of up to 138 percent of the poverty level.

That income cutoff is currently $17,236 for an individual or $35,535 for a family of four. More than 233,000 people were enrolled in the program as of Feb. 1.

The state phased in the requirement last year and in January for enrollees age 30-49 and is adding it this year for those age 19-29.

A lawsuit in federal court in Washington, D.C., contends President Donald Trump's administration violated Section 1115 of the Social Security Act when it approved the requirement by failing to consider the effect it would have on Medicaid's goal of providing health coverage to low-income people.

A hearing in the case is set for March 14.

A Section on 02/23/2019

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