Arkansas’ Medicaid work requirements increased the rate of uninsured in the state but has not affected employment, according to a new report from the Commonwealth Fund.
In fact, the number of adults in Arkansas between the ages of 30 and 49 who had Medicaid or marketplace coverage fell from 70.5% in 2016 to 63.7% in 2018. This almost 7% drop was not the same for non-Arkansas residents and adults from other age groups, which experienced between a 1.3% decrease and a 3.9% increase in insurance, the report siad.
Published in the New England Journal of Medicine, the study—led by Benjamin Sommers, M.D., of the Harvard T.H. Chan School of Public Health—examined how insurance coverage and employment have changed since Arkansas became the first state to implement the work requirements in 2018. The outcomes for adults in Arkansas were compared to adults in Kentucky, Louisiana and Texas. The analysis compared 30- to 49-year-olds in Arkansas to the state’s younger demographic, ages 18 to 29, and older demographic, ages 50 to 64.
Overall, the uninsured rate in the 30-to-49 group increased four percentage points from 2016 to 2018, with smaller or no changes in other groups. However, employer coverage for this age group increased a bit, from 10.6% to 12.2%. In addition, employment actually declined 3.5 percentage points between 2017 and 2018 for Arkansas citizens between the ages of 30 and 49. However, employment rates in other comparison groups had similar declines.
When asked about knowledge of the new law, many Medicaid beneficiaries were not aware of the work requirements or were confused about them, and nearly half of the target population was unsure whether the requirements applied to them. In fact, almost 33% of people between the ages of 30 and 49 had never heard of work requirements.
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After the state implemented the work requirement, 17,000 adults were removed from Medicaid in the final two months of 2018. Overall, in the first six months of the work requirements, the state suffered a significant loss in Medicaid coverage and a rise in uninsured rates, yet employment stayed pretty much consistent.
"Lack of awareness and confusion about the reporting requirements were common, which may explain why thousands of persons lost coverage even though more than 95% of the target population appeared to meet the requirements or qualify for an exemption," the report stated.
A Circuit Court in the District of Columbia recently took on and ruled against Medicaid work requirements both in Arkansas and Kentucky, but in April, the Department of Justice filed appeal notices for the rulings.
Currently, nine states have approval for Medicaid work requirements, and six states are pending approval.
A lawsuit challenging work requirements in New Hampshire has also been filed.