The state Department of Human Services will begin mailing letters this week notifying certain Medicaid expansion beneficiaries they must soon fulfill a work requirement to continue receiving health care coverage, the agency announced Monday

The work requirement, which was authorized by the Trump administration in March, applies to a subset of beneficiaries of Arkansas Works, the program providing insurance to some 280,000 low-income adults statewide. (Arkansas Works, which was enabled by the Affordable Care Act, or Obamacare, is credited with the state’s 50 percent reduction in its uninsured rate since 2013.) Starting in June, beneficiaries must show they worked at least 80 hours each month* or performed other “work activities,” such as attending school or job training.

In 2018, the work requirement will apply just to people ages 30 to 49. (The 19- to 29-year-old cohort will have to begin reporting in 2019, and those over the age of 50 will not be subject to the requirement.) Moreover, most beneficiaries in the 30-to-49 group will qualify for an exemption, DHS said in March. Exemptions include caring for a dependent child, attending school full time, attending a substance abuse program and other categories. But, depending on the type of exemption, some of those beneficiaries will still have to regularly report information confirming their continued exemption status. At the time, the agency said its data indicated about 60,000 of those beneficiaries ages 30 to 49 would be exempt and about 39,000 might be subject to the requirement.

DHS will be mailing separate letters to those it presumes will be exempt — for example, the agency knows some households contain dependent children, based on other benefits data — and those it presumes will be subject to the requirement. Here’s the sample letter to be sent to people who are presumed to be required to report work activities, and here’s the one for people presumed to be exempt. Both versions will be accompanied by a flyer attempting to explain what counts as both a qualifying work activity and what counts as an exemption.

It’s important to note that some beneficiaries might qualify for an exemption but not show up in DHS’ system as such. “Some people may have an exemption that DHS does not know about,” the press release acknowledges. (For example, a mother might qualify for the dependent child exemption but DHS may lack a record of that fact.) The version of the letter sent to people presumed to be subject to the reporting requirement does not contain mention of the exemption policy, though the accompanying flyer does.

All of this makes for a complicated and potentially confusing situation for tens of thousands of beneficiaries seeking to maintain coverage, and the DHS press release notes that “registered reporters” will be allowed to help beneficiaries with the reporting process.

“Both Arkansas BlueCross BlueShield and Arkansas Health and Wellness [Ambetter], two of the insurance carriers that cover Arkansas Works recipients, have voluntarily agreed to have registered reporters available to assist beneficiaries,” it states. In most states, private insurance companies like BlueCross don’t play a role in covering the Medicaid expansion population, but Arkansas created an unusual public-private partnership in which carriers receive Medicaid funds to provide coverage to beneficiaries. That creates an incentive for the insurers to ensure beneficiaries do indeed comply with the reporting requirements.

Arkansas’s reporting process itself is also unusual, in that beneficiaries will be required to prove their work activities (or show an exemption) only through a website, rather than by phone or mail. To maintain coverage, beneficiaries must create an account through a web portal at www.access.arkansas.gov, which DHS rolled out a month ago.

Here’s the full release from DHS:

LITTLE ROCK, Ark. —- This week the Department of Human Services is mailing Arkansas Works letters to beneficiaries who are subject to the work requirement in June and must begin reporting activities unless they are exempt.

DHS has produced this informational video explaining where Arkansas Works beneficiaries will find the important information in the letter coming this week.

For those who do not have an exemption and are required to report activities, they must report 80 hours of activities for the month of June. Those activities could be work, education, volunteer, or job training activities. Some people may have an exemption that DHS does not know about. Beneficiaries should report work activities and exemptions to DHS through the www.access.arkansas.gov website.

If beneficiaries have not created an online account and linked it to their healthcare coverage, they should do that now. To learn how to create an online account through www.access.arkansas.gov and link it to a beneficiary’s Arkansas Works coverage, you can watch this DHS video for step-by-step instructions or follow this written guide that walks through the process.

If someone believes they need help with reporting their hours, DHS has created a process that allows beneficiaries to choose a trusted individual to help them report their work activities or exemptions – just as they would today with family, insurance carriers, and hospital financial staff when applying for Arkansas Works.

The designated person will be called a registered reporter and will be required to complete a short online training that explains what information is required, how often work activities/exemptions need to be reported, and the importance of keeping people’s information confidential. Registered reporters will not have access to a beneficiary’s Social Security number. Both Arkansas BlueCross BlueShield and Arkansas Health and Wellness, two of the insurance carriers that cover Arkansas Works recipients, have voluntarily agreed to have registered reporters available to assist beneficiaries. For in-person assistance from DHS, beneficiaries can go to their local county offices.

Arkansas Works beneficiaries with BlueCross BlueShield coverage who need assistance from a registered reporter can call (800) 800-4298. Beneficiaries with Ambetter (Arkansas Health and Wellness) coverage who need assistance from a registered reporter can call (877) 617-0390.

To become a registered reporter, you will need to review training on reporting work activities and exemptions and linking accounts. You’ll also need access to the authorization, acknowledgement, and revocation forms.

More information about ARWorks can be found on the DHS home page by clicking the “Arkansas Works” button on the right-hand side of the page at www.humanservices.arkansas.gov.

*A previous version mistakenly said the requirement was to work for 80 hours per week.

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