Medicaid work requirements in Arkansas did not lead to an increase in employment, a key driver for proponents of the requirements, a new study found.
The study, published earlier this week in the journal Health Affairs, touches on the controversial practice of work requirements that has been struck down by courts. The study looked at the impact of Arkansas’ work requirement program, which became the only state to implement the requirements in June 2018.
“We found no evidence that the policy succeeded in its stated goal of promoting work,” according to the study conducted by researchers at the Harvard T.H. Chan School of Public Health.
Arkansas is one of 10 states that got approval from the Centers for Medicare & Medicaid Services (CMS) to install work requirements for certain able-bodied Medicaid beneficiaries.
But it is the only state to implement the requirements as court challenges slowed progress in other states.
By April 2019, a federal judge struck down the requirements, and an appeals court has upheld the ruling. At that point, 18,000 adults had already lost their Medicaid coverage.
Researchers performed a telephone survey near the end of last year of 2,706 low-income adults in Arkansas and three other states. The study then compared results to similar surveys from 2016 to 2018.
A major finding was that the requirements did not increase employment over 18 months of follow-up.
The survey found that 36% to 48% of respondents in Arkansas worked at least 20 hours a week, which was the requirement for keeping Medicaid coverage in Arkansas.
“Combining all qualifying working and community engagement activities, plus potential exemptions, more than 95% of the target population was already meeting the work requirements or should have qualified for an exemption,” the study said.
The study also found little change in the number of hours worked in the 18 months after the requirements were in effect.
The findings appear to undercut a key argument from the Trump administration, which first let states seek approval for work requirements a few years ago. Proponents such as CMS Administrator Seema Verma have argued that it is too soon to judge the program based on the experience of Arkansas.
“Less than a year does not allow us to distinguish between the operational challenges of implementation and the long-term effects of the policy itself,” Verma said in a speech before the National Association of Medicaid Directors in November. “Those with an ax to grind may wish to draw fatal conclusions from the early experiences of one state, but objective outsiders would do well to be more cautious.”
The study also found that most of the 18,000 coverage losses that stemmed from the implementation of the policy have been reversed.
Researchers estimate that the work requirements led to a significant increase in the uninsured rate of 7.1 percentage points for Arkansas residents age 39 to 49.
“But in 2019 after the court reversed the policy, uninsurance rates for the treatment group compared with control groups did not differ significantly, which suggests that overall uninsurance rates returned to levels seen before the work requirement,” the study said.
Researchers also found that awareness of the work requirement policy has been poor, a major concern from advocates who worry Medicaid beneficiaries didn’t know about the new requirements to report their employment to the state.
The study looked at Arkansas residents’ awareness and experiences with the requirements as of late 2019.
“Of Arkansans ages 30-49 with Medicaid or Marketplace coverage in the past year, 34.9% had heard nothing at all about the work requirements policy,” the study said.
It also found that knowledge about the status of work requirements was poor, as 70% of all state residents were unsure whether the policy was currently in effect.
There are some limitations with the study, namely that its survey response rate was 15%, lower than response rates for government surveys. They also couldn’t determine whether coverage losses or affordability changes were specifically due to the work requirement policy because “there was substantial confusion about the policy among respondents.”