Gov. Sanders initiates new attempt at work requirement for able-bodied Medicaid recipients

by Roby Brock ([email protected]) 913 views 

Gov. Sarah Sanders on Tuesday (Jan. 28) pitched the new Trump administration for a waiver to Arkansas’ Medicaid insurance program that will add a work requirement for able-bodied individuals.

The governor previously indicated she planned to make the waiver request, Arkansas’ second effort at adding a work requirement for a portion of its Medicaid population. Former Gov. Asa Hutchinson petitioned for the change, but it was blocked in a subsequent federal court ruling and later rejected by the Biden administration.

“President Trump declared it in his inaugural address: a new American golden age has begun. But our country cannot unleash unprecedented prosperity if able-bodied, childless adults sit on the sidelines. And we won’t slash our deficit if our welfare programs pay people to stay on the sidelines,” Sanders said in a letter to U.S. Department of Health and Human Services (HHS) Secretary-Designate, Robert F. Kennedy Jr.

“Today, I am submitting a waiver on behalf of the State of Arkansas to allow us to implement a work requirement for all able-bodied, working-age recipients of Arkansas’ Medicaid expansion program, ARHOME [Arkansas Health and Opportunity for Me]. Under the prior Trump Administration, Arkansas was successfully implementing a work requirement before federal litigation halted our progress. This new waiver reduces administrative hurdles and other issues for legitimate Medicaid expansion recipients while still achieving our policy goal: to have Medicaid serve as a safety net rather than a poverty trap,” she added.

The waiver would apply to all Medicaid expansion individuals ages 19-64 who are eligible through the new adult expansion group, who have income ranging from 0% to 138% of the federal poverty level (approximately $20,782 annual income), and who are covered by a QHP [Qualified Health Plan]. If they are not employed, they must be engaged in looking for work, education, or community service activities to keep their Medicaid expansion insurance. Community service could include caring for a dependent child, an elderly parent, or a person with a disability, the waiver said.

The new waiver request, known as a Section 1115 waiver to the state’s ARHOME program and called “Pathway to Prosperity”, is different this time, according to DHS officials. When a federal court struck down the work requirement in 2019, it noted problems with the compliance component of the initiative as well as state efforts to communicate a person’s status within the system.

There are three changes state leaders feel will make this attempt successful in gaining federal approval and potentially survive court challenges.

First, DHS officials plan to use “data matching” and “technology” to track compliance with the efforts to gain employment, community service, or further education. Previously, individuals were required to log in to a computer to document their efforts, but in this latest iteration, the onus will not fall on individuals. DHS said the way the system would work might include receiving information about efforts from various state agencies or schools, but details must still be worked out.

The waiver outlines a type of mentorship called a “success coaching,” where people will work with those looking for jobs, workforce education or community service. The success coaching will come from existing resources and partners, including other state agencies, DHS said.

Secondly, DHS said it planned to improve communications with the population they are targeting through phone, text, emails and advertising.

Finally, if an individual on Medicaid who is determined able-bodied for work does not comply, they will initially be suspended from their Medicaid expansion coverage or even traditional fee-for-service Medicaid. A grace period will allow them to come into compliance before being kicked off the program.

The governor has previously emphasized this waiver would only apply to “able-bodied” Arkansans, not Medicaid recipients who are disabled or incapable of holding a job. DHS estimates there are 220,000 able-bodied, working-age adults in Arkansas receiving healthcare through Medicaid. Of those recipients, estimates show nearly 90,000 have no job, according to the state. Officials said these estimates come from existing government data and they hope to be able to provide more accuracy and detail as they discuss the waiver with the federal government.

In its waiver application, DHS officials said they estimate the cost of “Pathway to Prosperity” to be $42.8 million over a five-year period. No new money is expected. Savings would be achieved from suspended ARHOME benefits and from individuals who move off Medicaid from the program’s expected success, according to the waiver application.

“Our goal is never to take services away from those who need it, but to help people stand on their own two feet so they don’t have to count on the government. There are 220,000 able-bodied, working-age adults in Arkansas receiving free healthcare courtesy of the taxpayer, costing us more than $2.2 billion each year – and growing. Of those recipients, estimates show nearly 90,000 have no job. Most Arkansans work hard to pay for their health insurance while these healthy adults do not work at all. That is a backward, broken system,” said Sanders.

“Work is more than just a steady paycheck. It is a way to build responsibility and learn skills. It is an escape from the compounding problems – crime, fatherlessness, hunger – facing our poorest communities. It is a way to get off the path to poverty and get on the path to prosperity. And with Arkansas’ record low unemployment rate, it’s not hard to find,” she said.

You can access the waiver request at this link.