The Trump administration approved a request from Arkansas allowing the state to require certain Medicaid enrollees work, volunteer, or take classes as a condition of staying enrolled in the program.
The administration did not make a decision on a second request from Arkansas whereby people making above 100 percent of the federal poverty level, or roughly $12,000 a year, would have been blocked from enrolling. Under the proposal, called a 1115 waiver, the state would have moved people above that income onto the health insurance exchanges to receive private coverage paid for mostly by the federal government. If both requests had been taken together, the state estimated that roughly 60,000 people would have fallen from Medicaid rolls.
The state and the Centers for Medicare and Medicaid Services decided to move forward with just one part of the waiver for now as they continue to discuss the request for the income cutoff.
"We did not want to delay the implementation of this very significant waiver today," said Arkansas Gov. Asa Hutchinson, a Republican, in announcing the change Monday.
Seema Verma, the CMS administrator who appeared in Arkansas to deliver the news, also indicated the question was open-ended.
"We wanted to make sure we were moving as quickly as possible on the waivers to go forward with," she said.
Though the state is the third to have its waiver approved, following Kentucky and Indiana, Hutchinson said he expected the work requirement would be rolled out first. Beginning in April people who would need to follow the work requirements — 80 hours a month are required — will receive a letter saying so and they will have to report monthly how they are meeting the requirement beginning in June. The state's Department of Human Services estimates $49.9 million in savings from the program.
The other portion of the waiver was being closely watched by other states. It isn't clear it would be allowed because Obamacare specifies the cutoff in its legislation.
The work and training requirements are controversial among people who view barriers to Medicaid enrollment as a strain on anyone enrolled in the program, who say that adding more paperwork could cause people to become uninsured even if they are meeting the requirements.
Brad Woodhouse, campaign director of the pro-Obamacare group Protect our Care, called the requirement "wrongheaded," saying it would "cut Medicaid and leave more vulnerable citizens without coverage."
"By imposing onerous monthly paperwork requirements on working people and forcing Arkansans with disabilities to re-prove their exempt status every two months, today’s Arkansas plan breaks new ground in needless and ideologically driven cruelty," he said.
But Hutchinson billed the program as one that would help move people "out of poverty and up the economic ladder."
States are increasingly asking the Trump administration to be allowed to add requirements to Medicaid enrollees to help reduce Medicaid rolls and to move people into jobs where they could receive private coverage.
Verma said eight other states have asked for the work and training requirements, while nine others have told the Trump administration they are interested. Groups have filed legal challenges against the requirements, saying that such a change isn't allowed through administrative action. States that expanded Medicaid under Obamacare extended government-funded coverage to anyone making less than roughly $16,000 a year, regardless of other factors such as disability or whether someone is working.
People are exempt from the requirements in Arkansas if they have a disability, are pregnant, a caregiver or have dependent children. The requirements also do not apply to anyone over the age of 50, and someone wouldn't lose Medicaid coverage unless they fail to report their hours for more than three consecutive months.
"It won't be a situation in which they will be surprised. If they are not in compliance they will be notified ... there will be an aggressive outreach program," said Cindy Gillespie, director of the Arkansas Department of Human Services.