The Arkansas Legislature will once again open its regular session with serious questions regarding the state's Medicaid program.
Lawmakers will convene in Little Rock on Jan. 11 for the 2021 regular legislative session.
In past years, the underlying issue was how the Medicaid expansion program could provide health care coverage to more Arkansans but also bolster the state's overall budget.
This year, lawmakers must consider what the loss of the state's work requirement will mean not just to the program but also to the state's budget -- all while waiting for the U.S. Supreme Court to weigh in on whether the work requirement can continue. The policy requires many adults receiving benefits to work 20 hours a week, participate in "community engagement" activities or qualify for an exemption to maintain coverage.
The nation's high court agreed last week to hear appeals from the state and the Trump administration of a lower court's decision earlier this year to strike down the state's long-standing requirement.
"Arkansas Works," as the overall program is now called, requires certain Medicare recipients to find or seek employment or job training or volunteer if they want the health care benefits, which are extended as part of the federal Patient Protection and Affordable Care Act.
The Legislature has been wrangling with the expansion of Medicaid ever since 2010, when the Obama administration first provided the means for states to extend Medicaid coverage to adults with incomes of up to 138 percent of the poverty level. The federal government pays most of the cost but states must contribute.
Then-Gov. Mike Beebe, a Democrat, worked with the Republican-led Legislature to implement the expansion and integrate it into the state's budget.
Four years later, it fell to newly elected Gov. Asa Hutchinson, a Republican, to keep the program alive as the state Legislature became increasingly conservative. Lawmakers eventually signed off after Hutchinson agreed to the initial work requirements to secure the overall program's passage.
The requirements themselves still needed federal approval, however, which the Obama administration declined to grant. Arkansas kept trying and the Trump administration granted the necessary waiver in 2018.
That's when the litigation, brought on behalf of Arkansas Medicaid recipients, began.
In a 2019 ruling, a U.S. district judge in Washington, D.C., struck down the requirements.
The U.S. Court of Appeals for the District of Columbia Circuit early this year unanimously upheld the lower court judge. The three-judge panel called federal approval of the plan "arbitrary and capricious" and asserted that it didn't address how the work requirement would promote Medicaid's objective to provide health coverage to the poor.
Arkansas' work rule had led to more than 18,000 people losing Medicaid coverage before it was first struck down in court.
And that was long before covid-19 visited itself upon this nation and state, sickening so many in the population and forcing an economic downturn that has eliminated jobs and forced more people into poverty.
Standard arguments for work requirements, which have also been struck down in other states that have tried them, ring hollow in this current, more desperate environment when health care is so sorely needed by so many.
Lawyers for the Medicaid recipients effectively argued the point in a court filing. Citing the millions who have filed for unemployment or lost employer-sponsored health insurance, they argued the work requirements "would allow states to kick people off Medicaid for failing to seek and obtain jobs that are not there."
However potent the arguments to the court may be, the Supreme Court decision could eventually be moot.
There will be a new federal administration in place come Jan. 20. President-elect Joe Biden's administration could reject the Arkansas work requirement.
Whatever happens, Gov. Hutchinson and Arkansas lawmakers will have to await the outcome to finalize the state's handling of Medicare -- and its impact on the state's budget.