KADIE CAMPBELL: One of the thousands of Arkansas Works recipients to lose coverage in 2018, Campbell regained it after spending hours on the phone with DHS and her insurance carrier — but noted many other beneficiaries don't have that luxury. BRITTANY WULF

A report released Tuesday by the state Department of Human Services showed another 1,232 beneficiaries on Arkansas Works — the state’s name for Medicaid expansion — lost coverage as of Jan. 1 due to Governor Hutchinson’ experimental work requirement. That brings to 18,164 the total number of low-income people kicked off the government-funded insurance program due to work rule noncompliance in 2018.

Here’s our recent cover story about the Medicaid work requirement and how it’s affected low-income Arkansans.

However, as of Jan. 1, everyone stripped from the program in 2018 was able to regain Arkansas Works coverage, assuming they still met other eligibility requirements such as income. The work requirement locks beneficiaries out of the program if they’re noncompliant for three months out of a given calendar year — but only for the rest of that year. People locked out in 2018 could begin the re-enrollment process in time to have coverage start again on Jan. 1, the state has said previously.

How many of those who were kicked off have signed back up? The DHS report released today says that “of the enrollees whose coverage ended in 2018 due to not meeting the requirement, 966 have applied for and gained coverage in 2019. Of those, 963 are in Arkansas Works.” In other words, only a small percentage of the 18,000 people locked out of coverage last year have so far regained it.

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Governor Hutchinson alluded to that number on Friday when a reporter asked him about the future of the work requirement. The governor noted that the number of previously terminated people now reapplying for coverage is “not overwhelming.”

“Now what does that mean?” he asked “Does it mean that these individuals got insurance elsewhere and so they have no need to re-enroll? Does it mean that they just don’t care? .. I think that that’s information that we’re going to learn increasingly over the next couple of months.”

Hutchinson suggested the relatively small proportion of former beneficiaries re-enrolling in Arkansas Works might help the state and the Trump administration defend the work requirement in a federal court case in which a group of plaintiffs is challenging the validity of the rule.

But Jennifer Wagner, a senior policy analyst with the Center for Budget and Policy Priorities, a progressive think tank based in D.C., said the low re-enrollment number was a result of “the complexity of the rules and process, not the lack of need for insurance.”

“Many beneficiaries who lost coverage in 2018 likely did not know they are eligible again as of January 1,” Wagner wrote in an email. “Considering that many who lost coverage due to the work requirement did not even know they were subject to the work requirement or understand what they needed to do to comply, I think it’s unlikely that those same individuals are aware of this detail in the complex policy. Others did not know they could reapply beginning in December for coverage effective January 1 or have circumstances in their lives that have prevented them from initiating a new application. Or, knowing that they will likely be terminated again in 3 months, some could be ‘saving’ their months of eligibility for when they need it most.”

Interviews with beneficiaries suggest that many have been unaware of the work requirement or are confused about its complicated details. Critics of the policy have pointed to the very low rate of people who are reporting work hours each month as evidence that the requirement isn’t functioning as intended. Data suggest that many of those people may be working or qualify for an exemption but simply aren’t reporting the information to the state.

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The latest DHS report shows that there were 60,680 subject to the work requirement in December, out of whom 4,776 “did not meet [the] requirement” that month. The DHS report states that 55,904 met the requirement “due to work, training or other activity.”

However, the document does not make it clear that only 1,311 actually reported work activities, a number buried in a table on page 3 of the PDF. (Earlier versions of the monthly report stated this number in large type on the first page.) The vast majority of those who “met the requirement” in December, like previous months, didn’t report work hours themselves. Instead, they were automatically deemed to be in compliance or exempt based on information DHS already had on file.

Legal Aid of Arkansas attorney Kevin De Liban, who is among the lawyers representing the group of beneficiaries suing to block the work requirement, noted that the low re-enrollment numbers indicate there are still “another 17,000 people who had health insurance coverage as recently as August who don’t now.”

De Liban said one reason people may not be reapplying for coverage — aside from not knowing the details of DHS policy — is that dealing with the agency can be notoriously frustrating. Many beneficiaries have described losing coverage for reasons they don’t understand and being forced to spend hours on the phone with DHS to resolve minor paperwork issues. That alone may deter people with busy lives from re-enrolling.

“The consistent message [Arkansas Works beneficiaries] have heard loud and clear is that the state doesn’t want them to have health insurance coverage,” De Liban said. “You can imagine some level of frustration also at having to go through another hoop-laden, bureaucratic process where you have to fill out a long application, you have to provide all sorts of documentation to DHS that you probably just provided them a few months ago, you have to deal with long phone wait times or workers who may not be the friendliest, perhaps because they themselves are overworked. … It can be confusing and frustrating, even if you have the knowledge.”

The Arkansas Nonprofit News Network previously profiled Kadie Campbell, a 38-year-old Arkansas Works recipient who rearranged work life to meet the requirement — and still lost coverage, seemingly due to a DHS error. “I have the luxury of being able sit around on the phone for as long as it takes to get ahold of somebody — and being eloquent enough to explain my situation,” Campbell said in November. “I’m savvy with a computer system. I’m working diligently to become a productive member of society. … If I’m getting screwed, then how many other people are?”

The three-month lockout clock reset once the new year began, so the work rule won’t end coverage for any additional beneficiaries until the end of March. Beginning on Jan. 1, the rule began applying to a new cohort of Arkansas Works beneficiaries: those ages 19-29. In 2018, it only applied to those ages 30-49. (Beneficiaries age 50 and above won’t be subject to the requirement.)

A technical note: Those who have followed the work requirement issue closely may notice the coverage losses at the beginning of January (1,232) were much smaller than those at the beginning of December (4,655) and previous months. The reason is that the state staggered its implementation of the rule by dividing the 30-49 age group into four quarters. Call those Groups A, B, C and D. (It assigned people to these groups semi-randomly, based on the month of the year in which the beneficiary had originally applied for Arkansas Works.)

Group A became subject to the requirement in June 2018, meaning they hit their three-month cutoff mark on Sept. 1; that month, 4,353 lost coverage. Group B became subject to the requirement in July and hit the three-month cutoff on Oct. 1, and so on. Therefore, coverage losses at the beginning of September, October, November and December, taken in total, represent the initial coverage losses for the entire 30-49 cohort. Most of those remaining in the program after Dec. 1 were those who were auto-exempted from reporting for one reason or another — because the rule had by that point terminated coverage for most of those who were not auto-exempted by DHS.

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