FULL SPEED AHEAD: Governor Hutchinson and DHS Director Cindy Gillespie (right) at a recent press roundtable on Medicaid. BRIAN CHILSON

On Saturday, Sept. 1, a group of Arkansans will almost certainly lose their health insurance due to noncompliance with the state’s new work requirement for a certain subset of Medicaid beneficiaries. They’ll still have a few days (until Sept. 5) to retroactively report information and get their coverage reinstated.

Here’s the online portal at which beneficiaries should report work activity hours (or an exemption) to the state Department of Human Services. Beneficiaries can also get assistance by contacting their insurance carrier at one of the following numbers, provided by DHS:

Arkansas Blue Cross Blue Shield: 1-800-800-4298
Ambetter: 1-877-617-0390
QualChoice: 1-866-838-9186

Those who lose coverage tomorrow — likely numbering in the thousands, based on numbers released from DHS last month — will be the first in the history of the Medicaid program, in any state, to be dropped from coverage because of such a rule. Arkansas is one of several states that received permission from federal health authorities to implement a work requirement for certain non-disabled adults earlier this year, but it’s the only one to successfully get its mandate off the ground. The requirement has been championed by Governor Hutchinson.

Advertisement

A work requirement in Kentucky was blocked by a federal judge in June after beneficiaries and health care access advocacy groups sued. A similar suit was filed in Arkansas in August but has yet to be acted upon by the court.

The September 1 date is important because it marks three months since the requirement first went into effect for some beneficiaries, on June 1. Under Arkansas’s rule, if a beneficiary has not reported work activities or an exemption for three months out of the year, he or she will automatically lose coverage. The beneficiary then has a brief grace period — until the fifth day of the month — to report retroactively. If the beneficiary doesn’t do so by 9 p.m. on Sept. 5, he or she will be “locked out” of the program for the remainder of the calendar year, meaning he or she will be ineligible until January 1, 2019.

DHS figures released earlier this summer show a little over 7,000 people were out of compliance for the month of June. Of those, 5,476 remained non-compliant for a second month, in July. DHS will release noncompliance numbers for August in the coming days, but it’s extremely unlikely that all of those 5,476 beneficiaries successfully reported their information in August.

Arkansas’s work requirement applies only to a group of people on “Arkansas Works,” the health insurance program for low-income adults created by Obamacare’s expansion of Medicaid. There are about 265,000 Arkansas Works recipients in total. This year, only adults ages 30-49 are subject to the requirement, and, next year, the 19-29 age group will be added. (Those ages 50-64 will not be subject to the requirement.) Beneficiaries have to report at least 80 hours per month of work activities (including volunteer hours and school) or else be eligible for an exemption, such as having a dependent child in the home. Most beneficiaries are eligible for an exemption, and many were automatically granted an exemption by DHS based on data the agency already had in its system.

However, for the thousands of beneficiaries who not automatically exempt, the work rule may pose a significant challenge. Work activities can only be reported through an online portal — rather than by phone or mail — which may be inaccessible during much of the day. Many beneficiaries may be unaware of the requirement, or may wrongly assume that if they are working, they are meeting the rules. Yet it’s not enough to simply be employed: Beneficiaries must create an account via the online portal and report their hours on a monthly basis. (Most Medicaid expansion beneficiaries do indeed have jobs, data shows.)

Since the lockout won’t begin until the fifth day of the month, why will coverage end for beneficiaries on the first of the month? Marci Manley, a spokesperson for DHS, explained the issue as follows:

Advertisement

The coverage will initially close effective at the end of Aug. 31. So as of Sept. 1 – someone who had not met the requirement for two months already and had not reported at that time enough activities to meet the work requirement would have their coverage terminated effective Aug. 31 and the system would show their coverage as no longer active.

However, if they report between Sept. 1 and Sept. 5 at the deadline, their case would be reopened retroactive to September 1st. The reason for that is that the coverage is monthly coverage from first of month to end of month. The Sept. 1 – Sept. 5 grace period gives them additional time to keep their coverage.

If they do not report activities/exemptions and meet the work and community engagement requirement by the deadline on Sept. 5 (by 9 p.m.) then their coverage would remain closed, and they could reapply for coverage at the start of the next calendar year.