A nonpartisan legislative agency tasked with analyzing Medicaid sent a letter to the Trump administration on Thursday saying it was “highly concerned” about Arkansas’s termination of insurance for almost 8,500 beneficiaries in recent months as a result of the state’s work requirement for certain beneficiaries. 

MACPAC, the Medicaid and CHIP Payment and Access Commission, called for “a pause in disenrollments in order to make program adjustments,” noting the low rate of reporting among those beneficiaries subject to the requirement. Most people in the target age range for the work requirement qualify for an exemption under the rules Arkansas created.

However, among those beneficiaries who are required to report, “91.6 percent … failed to do so in September 2018,” the letter said. That sends “a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” it said.

People who do not report their work hours for three months out of the year are locked out of coverage until the following calendar year.

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The letter, which was sent to U.S. Department of Health and Human Services Secretary Alex Azar, also expressed concerns about a number of other issues with Arkansas’s work rule. For one thing, the state requires beneficiaries to report their work hours online, even though Arkansas has limited internet access. The Arkansas Department of Human Services says it has set up a means for people to report their work hours information by phone by relaying the information through “registered reporters” — insurance agents, social workers or others — but MACPAC says Arkansas DHS “was unable to provide MACPAC with information on how many beneficiaries are taking advantage of that assistance.”

Similarly, the letter criticized the state’s focus on performing beneficiary outreach online or through social media as “problematic given the low level of Internet access” in Arkansas.

MACPAC also noted the state has not yet developed an evaluation design to test whether the work requirement meets its stated policy goals. Arkansas submitted a draft evaluation design months ago. But on Nov. 1, as the Arkansas Nonprofit News Network recently reported, the federal Centers for Medicare and Medicaid Services (CMS), which directly oversees Medicaid, rejected Arkansas’s proposed evaluation design as flawed and asked the state to make revisions. (CMS is a branch of the federal Health and Human Services Department.)

Arkansas refers beneficiaries to the state Department of Workforce Services if they need help finding a job, but the state hasn’t devoted substantial new resources to DWS. And, the letter says, “data currently are not being reported on the extent to which beneficiaries are accessing such services, what services they are asking or qualified for, which barriers may exist for their use of these services, and whether services are being delivered.”

The letter said the panel was not taking a position on the issue of work requirements in general, just on Arkansas’s implementation.