On Monday, six new plaintiffs were added to the federal lawsuit that aims to halt Arkansas’s experimental Medicaid work requirement, including two people who were recently removed from their insurance as a result of the rule. (One has since regained coverage by way of a “good cause” exemption granted by DHS; the other is attempting to do so.) That brings the number of Arkansas Works beneficiaries in the suit to nine.

About 8,500 people have been removed from Medicaid due to the work requirement since it began in June.


Here’s the amended complaint in the case, Gresham v. Azar.

Among the additional plaintiffs is Adrian McGonigal, described as a “40-year-old man who lives in Pea Ridge.” McGonigal has chronic obstructive pulmonary disease, or COPD, which he manages with prescription medication. In August, he started a new job at a poultry processing plant, where he worked “between 30 and 40 hours per week in the shipping department and earned approximately $1200 per month before taxes.”


However, the complaint says, McGonigal lost his job last month, in large part due to increased illness as a result of losing his insurance. He lost his insurance because he didn’t report his work hours under the state’s new rule, which require people to log on to a website and record 80 hours or more of “work activities” on a monthly basis.

Since 2014, McGonigal has been a beneficiary of Arkansas Works, the state’s Medicaid expansion program for low-income adults. (The income eligibility threshold is 138 percent of the poverty line, or about $16,753 for an individual.) McGonigal was told in June that the work requirement would apply to him, but (like many people) he was confused by the complex requirements of the program and had trouble reporting online. He doesn’t own a computer or smartphone and lacks transportation to get to a library. “He tried to report his work activity by calling the local DHS office, but was told he could only report online,” the complaint states.


His family helped him report in June, and he mistakenly thought that this single act of reporting “was all he needed to maintain his coverage.” However, the rule requires reporting every month; three months noncompliance results in termination and a lockout for the rest of the calendar year. McGonigal learned in October that his insurance had been cut off when he was denied a refill of his prescription, leading to a flare-up of his COPD and an eventual visit to the emergency room.

With the help of Legal Aid of Arkansas, which is representing the plaintiffs in the suit, McGonigal was able to pursue a “good cause” exemption from DHS. It was granted last week and he’s now in the process of restoring his coverage. (The rules surrounding “good cause” exemptions are vague, and it’s not clear that someone in McGonigal’s situation without an attorney would be able to wrangle leniency from the agency.) Nonetheless, because he missed multiple days of work, he was fired from his job due to absences.

The other plaintiffs are Anna Book of Little Rock, Russell Cook of Little Rock, Veronica Watson of Moro, Treda Robinson of Searcy and Jamie Deyo of Lonoke.

The plaintiffs are represented by Legal Aid, along with the National Health Law Program and the Southern Poverty Law Center. The latter two groups helped file suit in a similar case in Kentucky, which led to that state’s work requirement being struck down by a federal judge in June before the policy had a chance to go into effect. Arkansas is therefore the only state in the nation that has implemented a work requirement in its Medicaid program, though several other states are seeking to do so in 2019. The Arkansas case is before the same judge, James E. Boasberg.


The defendants in the case are the federal agencies and their heads who approved Arkansas’s work requirement proposal: Health and Human Services Secretary Alex Azar, Medicare/Medicaid Administrator Seema Verma, the Department of Health and Human Services and the Center for Medicare and Medicaid Services. Attorneys for the plaintiffs say HHS and CMS overstepped their authority in approving Arkansas’s waiver that created the work requirement.

The lawsuit, which was originally filed in August, is a long way from resolution. The briefing schedule runs through mid-January.