DHS

This post has been updated.

The number of Arkansans covered by Medicaid rose by almost 12,000 people from March 1 to April 1, according to a monthly report released today by the state Department of Human Services.

Most of the increase — about 6,700 — came from a rise in the number of children covered by ARKids, which is primarily funded by Medicaid. There were about 416,000 kids covered by ARKids as of April 1.

But the Arkansas Works program — the state’s name for Medicaid expansion, which covers low-income adults — also saw an increase of about 4,200 from March to April. As of April 1, there were about 240,000 adults enrolled in the program.

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Though the rise is modest, it is notable because the expansion population has shrunk almost every month for the past two years. Enrollment in the program peaked at around 330,000 in early 2017 but has been declining ever since.

Enrollment for the expansion group also rose slightly last month, increasing by about 1,100 from February to March.

Until recently, most Medicaid expansion beneficiaries under age 50 were subject to a requirement that they report 80 hours of “work activities” to DHS every month. Those who did not report sufficient hours for three months in a calendar year were kicked off the program and locked out of reapplying for the remainder of that year. Arkansas was the first state in the country to implement such a policy. About 18,000 people lost insurance in 2018 due to noncompliance. It’s unknown how many of those people were not working and how many were working but simply did not report their hours.

In March, a federal judge blocked the work requirement, saying Trump administration officials — who blessed Arkansas’s experiment by granting the state a waiver — had not properly considered the coverage losses likely to result from the policy. The Trump administration is appealing the decision, and Arkansas is an intervenor in the case.

It’s not clear what has prompted the recent enrollment uptick. The court ruling that ended the work requirement did not automatically reinstate any of those who lost coverage last year, though they may reapply for Medicaid on their own accord. (They have been free to do so as of Jan. 1.)

It also does not appear that the increase is being driven solely by re-enrollment of those who were previously kicked off as a result of the work rule. Only 2,781 of the beneficiaries who lost coverage in 2018 due to work requirement noncompliance have regained coverage at some point in 2019, according to a figure supplied by DHS spokeswoman Amy Webb. That’s a smaller number than the monthly increase in Arkansas Works enrollment from March to April alone.

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DHS had not responded to a request for further explanation of the uptick as of Monday afternoon.

Governor Hutchinson’s office also did not immediately respond to a request for comment on Monday afternoon. The governor has previously highlighted the decline in the Medicaid rolls as an indication of a strong economy and improved efforts by DHS to “scrub” the system of ineligible people.

In addition to the Medicaid expansion group and ARKids, the adult “traditional Medicaid” population grew by about 1,000. This group, which was around 238,000 as of April 1, includes the elderly and adults with disabilities.

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A few additional notes:

It’s possible that news coverage of the decision striking down the work requirement could now be driving some people to now enroll in Arkansas Works, even though the work rule itself wasn’t actually barring anyone from re-enrolling as of Jan. 1. However, because the decision didn’t arrive until March 27, it can’t explain the increased enrollment from March 1 to April 1.

It also may be that some people who were last year disenrolled from Medicaid for reasons other than the work requirement are just now signing back up. In addition to the 18,000 who lost coverage because of work rule noncompliance, tens of thousands of other beneficiaries were dropped from the Medicaid rolls last year, many for prosaic reasons such as lost paperwork. (Anecdotally, many beneficiaries report barriers to getting and maintaining coverage, including excessive red tape at DHS.) But public understanding of the work requirement and Medicaid generally is low.

Many people who lost coverage for other reasons may have thought the work rule was to blame. Some of those former beneficiaries may have been under the impression they were locked out of Medicaid until recently.

Finally, it’s worth noting the well-documented correlation between expanding access to health coverage for adults and an increase in coverage for kids. When parents sign up for insurance, they tend to sign their kids up for insurance, too. This is sometimes called the “welcome mat effect” or the “woodwork effect” by policymakers.

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