After a state report on Monday showed Arkansas’s Medicaid work requirement ended insurance coverage for 4,600 more people at the beginning of December, Governor Hutchinson issued a statement defending the rule. He pushed back against critics who say most beneficiaries have reported no “work activity” hours at all each month, which suggests they may be having trouble navigating the state Department of Human Services’ system for reporting hours or exemptions. (Some 17,000 have lost coverage since the requirement began earlier this year.)

The governor said by email on Monday that the recent DHS report showed “87 percent of those subject to the work requirement complied” in November, up from 73 percent in August. “This is a strong indication that more and more people are learning about the requirement and following through with their reporting,” he said.

But the Center for Budget and Policy Priorities, a D.C.-based think tank, says Arkansas’s compliance rates remain low. In an analysis of the most recent DHS report, Jennifer Wagner, a senior policy analyst, wrote that “around 80 percent of those who had to report exemptions or work hours failed to do so last month.”

How does that figure square with Hutchinson’s? Are most beneficiaries complying or not? And how many Arkansans are actually reporting 80 hours of “work activities” each month?

First, a word on definitions. Most people on Medicaid are not subject to the work requirement, including children on ARKids, those on federal disability and anyone age 50 or older. Even among those beneficiaries who are subject to the work requirement — about 64,743 last month — most are exempt from monthly reporting for various reasons. And most of the “exempt” group were automatically granted their exemption by DHS based on information the agency already had on file.

When someone applies for Arkansas Works (the state’s name for Medicaid expansion), he or she must provide proof of income and various household information. He or she must also update that paperwork annually, a process called “redetermination.” When DHS began implementing the work rule in June, it auto-exempted every beneficiary with a dependent child in his or her household. The recent report shows 6,765 people fell into that category last month. Another 9,984 beneficiaries were exempt because DHS data showed they were participating in the SNAP program (food stamps), which contains its own work requirement. The largest group of beneficiaries exempted by DHS — 25,149 in November — were deemed exempt because their self-reported income at application or redetermination showed they made above $680 per month at the time. (DHS uses income as a proxy measure for work hours. Since $680 = $8.50 x 80, the agency assumes anyone who made that much money per month at the time of their application worked at least 80 hours a month at minimum wage.)

In all, 53,975 beneficiaries were declared exempt from reporting last month. That’s about 83 percent of the approximately 65,000 people subject to the requirement. Again, most of them were automatically exempted by DHS and have never reported information that specifically pertains to the work requirement. But, the governor says they still complied with the rule.

“Just because some of them are automatically exempt, it’s still a form of compliance,” J.R. Davis, a spokesman for the governor, said when asked about the accuracy of Hutchinson’s statement. DHS makes its automatic exemptions based on information provided by the beneficiary in an application or at redetermination, Davis noted. Therefore, “those individuals still have to reach out to DHS with that information at some point in the process.”

The Center for Budget for Policy Priorities analysis, however, measured compliance by looking only at those 10,768 beneficiaries who were subject to the work requirement but not exempt from reporting last month. Focusing just on that group (composed of the green and blue bars of the figure at right) there were 8,426, or about 78 percent, who failed to report 80 hours. (In fact, almost all of them, or 8,308, reported nothing at all.)

The remaining beneficiaries either met the reporting requirement (1,428) or manually reported an exemption sometime in November (914).

Davis noted, however, that even if one excludes the auto-exempt beneficiaries (the orange bar in the above figure) and looks only at those people who were required to report something last month, Arkansas’s compliance figures have still improved over the past several months. In August, 17 percent of that group was satisfying the requirement. In November, the number had crept up to 22 percent.

Therefore, he said, it was still accurate to say that “more and more people are learning about [the work requirement] and more and more people are following through with that reporting.” He acknowledged criticisms that many beneficiaries remain unaware of the work requirement or exactly what is expected of them, noting (as did the governor) that DHS recently announced it was creating a new phone “helpline” for beneficiaries to report their hours and would soon launch a paid advertising campaign to raise public awareness.

“We’re doing everything we can at this point,” Davis said. “We’re not at all saying that we’re above looking at different ways of doing things. We want to make sure that these folks know what’s expected, what the requirement is. … So I think you’ll continue to see that tick up as we reach out to folks.”

Wagner, the policy analyst, said she was skeptical of even those modest gains in reporting compliance. In a phone call, she noted that the state is exempting more people over time: 40,190 were exempt from reporting in August, versus 53,975 in November.

“The other factor is that they’ve terminated large portions of the cohort each month,” she said. “If you kick off the vulnerable ones and increase the state exemptions, then your numbers are going to look better.”

Wagner pointed out that out of the approximately 65,000 subject to the requirement in November, fewer than 1,500 actually satisfied the reporting requirement by turning in hours. “What I look at each month is the ‘satisfied reporting’ number … and that has consistently been around 2 percent [of those subject to the work requirement],” she said.

Here’s the full statement Governor Hutchinson issued Monday:

While we’re still in the early stages of the work requirement’s implementation, we’re already seeing significant signs that the program is accomplishing its intent. Since June 1, more than 4,100 Arkansas Works beneficiaries have moved into work, which is the primary goal of this initiative. In addition, the rate of compliance continues to improve month after month. For November 87 percent of those subject to the work requirement complied, compared to just 73 percent in August. This is a strong indication that more and more people are learning about the requirement and following through with their reporting.

I expect this trend to continue with the announcement from DHS last week that they are launching a paid media campaign and expanding the phone reporting option of the program with a toll-free line directly to the agency. While participants have always had the option to call, this decision by DHS underscores the agency’s commitment to provide every opportunity possible for Arkansas Works participants to report their compliance.

As for those who did not comply and, as a result, lost coverage, they will have an opportunity to re-enroll in January.”

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.