WHAT'S TO SMILE ABOUT: Gov. Asa Hutchinson and Medicaid director Seema Verma cheer Arkansas's work rule, since struck down by the courts. KUAR Public Radio
KUAR Public Radio
WHAT’S TO SMILE ABOUT: Gov. Asa Hutchinson and Medicaid director Seema Verma cheer Arkansas’s work rule, since struck down by the courts.

Arkansas’s ill-conceived and implemented work rule for Medicaid coverage has been well covered and now it’s become a standard for others to avoid.

Indiana is forging ahead with a work rule, despite court rulings against Kentucky and Arkansas. Catch this in a National Health Law report:


Dr. Jennifer Walthall, Secretary of Indiana’s Family & Social Services Administration, argued that other states approaches are “fundamentally different” from Indiana’s. The bottom line: we can’t ignore something that’s illegal. And beyond that, we need to call out Indiana’s attempt to distance itself from the Arkansas calamity. Because when we look under the hood, we’ll find Indiana’s rather superficial differences will do little to prevent coverage losses like we saw in Arkansas. In fact, some of these policies may well make things worse.


For example, Indiana will phase in the number of required monthly hours before reaching 80 hours per month in mid-2020. Arkansas maintained a constant 80 hour threshold, but phased in by age group and region. During autumn 2018, about four out of five people who needed to actively report compliance (hours or exemption) either did not report or reported no hours at all. Interviews with enrollees point to poor state outreach and widespread confusion about what the requirements were and how to actually report. It is not clear how Indiana’s staggered phase in will resolve this reporting problem, especially given the evidence of ongoing confusion around preventive care incentives and health accounts in the so-called Healthy Indiana Plan (HIP). Moreover, changing the required monthly work hours every three to six months during rollout will likely exacerbate confusion.

Indiana’s reporting process itself may also lead to mass confusion and coverage loss. Unlike Arkansas, Indiana chose to postpone its compliance review to December each year. While this avoids the rolling monthly coverage loss reports that raised alarm bells in Arkansas, it greatly increases the chance of a massive suspension of benefits at year’s end. With no warning notices until November, expect tens of thousands of previously unaware enrollees to spend December scrambling to navigate a new reporting system, backdate their monthly reports, and recall when and where they worked since June. Those who fail to do so face coverage suspension for all of 2020. They will regain coverage only if they know to complete and report required work hours or exemptions in the following year. In Arkansas, fewer than one in four terminated enrollees had reenrolled as of mid-May, five months after their lockout period ended.


Certainly, Arkansas’ rollout was disastrous, but there is little evidence that Indiana’s will be substantially better.

In short: How bad is the Indiana plan? EVEN WORSE THAN ARKANSAS! And that’s bad.