The Trump administration today approved Kentucky’s request for a waiver of Medicaid rules to implement certain changes to its Medicaid expansion program, including work requirements. Governor Bevin is making the official announcement at 1:30 EST (Update: Here’s a livestream of the announcement via Bevin’s Facebook page).

Governor Hutchinson is also seeking to impose work requirements on the Medicaid expansion program in Arkansas. Kentucky was the first domino; approval for Hutchinson’s work requirements request is inevitable. However, Hutchinson is also asking to reduce eligibility in the program, which is considered a tougher ask. Currently Medicaid expansion covers adults who make less than 138 percent of the federal poverty level; Hutchinson wants to move that line to 100 percent of FPL, booting 60,000 working poor Arkansans from the rolls. I asked officials from the federal Center for Medicare and Medicaid Services (CMS) yesterday about the state’s request for an eligibility request and they declined to comment, saying that issue is still under review. So I would expect a response to the Arkansas waiver request relatively soon, but Hutchinson’s eligibility ask may slow things down a bit. While there has been some reporting that some in the Trump administration are leery of the eligibility change, Hutchinson has continually expressed confidence that it will be approved along with work requirements.


In addition to work requirements, the Kentucky waiver includes imposing small premiums on a sliding scale for beneficiaries at all income levels, a lockout period of up to six months for beneficiaries who make more than the poverty line if they fail to keep up with payments or miss certain paperwork deadlines, a convoluted version of health savings accounts, eliminating non-emergency medical transportation, and other changes.

The letter to Bevin’s office from CMS states that the work requirements, which the Trump administration insists on referring to with Orwellian language “community engagement,” will “promote Medicaid’s objective of improving beneficiary health.” This is a dubious contention, and lawsuits to this waiver approval will be coming shortly precisely because these waivers are required by law to “promote the objectives” of Medicaid, a law designed to provide a healthcare safety net that says nothing about work.


Form the feds’ letter, here’s an overview of the Kentucky work-requirements plan:

Kentucky will implement a community engagement requirement as a condition of eligibility for adult beneficiaries ages 19 to 64 in the Kentucky HEALTH program, with exemptions for various groups, including: former foster care youth, pregnant women, primary caregivers of a dependent (limited to one caregiver per household), beneficiaries considered medically frail, beneficiaries diagnosed with an acute medical condition that would prevent them from complying with the requirements, and full time students. To remain eligible for coverage, non-exempt beneficiaries must complete 80 hours per month of community engagement activities, such as employment, education, job skills training, and community service. Beneficiaries will have their eligibility suspended for failure to demonstrate compliance with the community engagement requirement and will be able to reactivate their eligibility on the first day of the month after they complete 80 hours of community engagement in a 30-day period or a state-approved health literacy or financial literacy course. Beneficiaries who are in an eligibility suspension for failure to meet the requirement on their redetermination date will have their enrollment terminated and will be required to submit a new application. Kentucky will provide good cause exemptions in certain circumstances for beneficiaries who cannot meet requirements. 

Hutchinson’s request for work requirements is broadly similar. It would impose work requirements on many beneficiaries in the state’s Medicaid expansion program, which covers low-income adults. Those between the ages of 18-49 would be required to work 80 hours per month; if they are not working, they would have to participate in job training programs, job searches, or certain approved volunteer activities. Beneficiaries must be in compliance for nine months out of the year or they would be removed from the program for the duration of the year.


Beneficiaries 50 or older would not be subject to the work requirement. Exemptions would be available for others who met certain criteria, including full-time students, those caring for an incapacitated person, those caring for dependent children in the home, people receiving unemployment benefits, those who are medically incapacitated due to physical or mental health problems, those participating in a drug or alcohol addiction treatment program, and pregnant women. The state’s Department of Human Services projects that around half of Arkansas Works beneficiaries would be eligible for an exemption.

Non-exempt beneficiaries will have to report their work activity on a monthly basis. They will do so via a website, which is still under development; kiosks will be available in county offices for people who can’t access the site via a computer or other device. Both the DHS and insurance companies will send notices, including emails, if someone is noncompliant, reminding them to report.