ARHOME work requirements bill passes Senate panel

A bill amending the work requirements for participants in Arkansas’ ARHOME Medicaid expansion program passed the Senate Insurance and Commerce Committee Thursday (April 3).

Senate Bill 527 by Sen. Missy Irvin, R-Mountain View, changes the Arkansas Health and Opportunity for Me (ARHOME) program created in 2011.

It passed on a voice vote with no audible dissenters. No one spoke for or against it.

Senate Bill 527 modifies existing state law, which already allows the governor to request a work requirement waiver as a condition for recipients continuing to receive coverage under ARHOME.

The bill states that individuals must comply with all federal and state work requirements under the state’s Medicaid program. It advanced with an amendment requiring participants to provide information to demonstrate compliance. It also specifies that the consequence for noncompliance is suspension.

The consequence would be suspension rather than disenrollment so individuals’ benefits could be rapidly restored.

Arkansas submitted its waiver request for a work requirement to the Centers for Medicaid and Medicare Services last week. State officials are calling this latest request the “Pathway to Prosperity.”

The bill is part of Gov. Sarah Sanders’ legislative agenda. In announcing the pending waiver request in January, Sanders said, “The requirement is simple. If you want to receive free health care paid for by your fellow taxpayer, (then) able-bodied, working age adults have to work, go to school, volunteer, or be home to take care of their kids.”

Sanders said 220,000 adults receive coverage through the state’s ARHOME program at a cost of $2.2 billion annually. She said in January that 90,000 of the recipients didn’t have a job. At the time, her administration said the waiver would reduce the state’s costs by $122.8 million over five years.

ARHOME is the state program created as a result of the Affordable Care Act, otherwise known as Obamacare. The federal law expanded the number of Arkansans eligible for Medicaid to include able-bodied adults ages 19-64 with incomes of up to 138% of the federal poverty level.

States had the option of participating in the program as a result of a U.S. Supreme Court ruling. Arkansas chose to participate during Gov. Mike Beebe’s administration. Rather than enrolling those individuals in traditional Medicaid, it obtained a waiver from the Obama administration allowing it to use those federal dollars to purchase private insurance for them.

Under Senate Bill 527, individuals would be exempt from the work requirement if they:

• Volunteer 20 hours or more per week as determined by the Department of Human Services;
• Meet any combination of working and participating in a work program for at least 20 hours per week as determined by the Department of Human Services;
• Comply with the requirement of a workfare program;
• Receive unemployment compensation and comply with work requirements that are part of that system;
• Participate in a drug addiction or alcoholic treatment or rehabilitation program;
• Provide care for a dependent child who has a serious medical condition or disability or is under age 6;
• Care for a dependent child who is medically certified as physically or mentally unfit for employment and/or is pregnant, under 19 years of age, or older than age 59.

The bill also increases the medical-loss ratio required of individual qualified health insurance plans participating in the ARHOME program to 90% from the current 80%. The medical loss ratio is the “percentage of premium income that health insurers spend on medical care and quality improvement as opposed to administration, marketing, and, if applicable, profit,” the bill states.

Sanders’ predecessor, Gov. Asa Hutchinson, implemented the nation’s first work requirement as part of the program he called Arkansas Works. Under that waiver obtained from the first Trump administration, individuals who failed to meet the requirement three months in a calendar year were subject to losing their coverage.

A federal judge blocked it in March 2019, saying the work requirement did not help the program achieve Medicaid’s purpose of providing health coverage.

Irvin told the committee April 3 that “we’re trying to follow the model that other states have followed that have not been tossed out by a court.”

At Sanders’ news conference announcing the waiver, Department of Health and Human Services Director Kristi Putnam and state Medicaid Director Janet Mann said the Pathway to Prosperity amendment would take into account lessons learned from the previous effort.

Those include simplified reporting requirements that tripped up some recipients. It will use data matching — comparing data from different sources — to identify individuals who need extra support. Recipients can receive focused care coordination services. Those include a personal development plan, success coaching, and connection to community resources. Mann said there will be a focus on communication and personal contacts rather than an over-reliance on technology.