Medicaid Recipientsâ€™ Early Experience With the Arkansas Medicaid Work Requirement
By Jessica Greene
Health Affairs Blog, September 5, 2018
In June, Arkansas became the first state to implement a work requirement in its Medicaid program.
Little is known to date about how those impacted by the new Medicaid work requirement feel about the policy. To explore Medicaid recipientsâ€™ attitudes about Arkansasâ€™ work requirement and their early experiences with the policy, in mid-August I conducted in-depth interviews with 18 adult Medicaid recipients in northeast Arkansas.
While this group is far too small to provide generalizable results, the interviews do illustrate how the state’s policy is interacting with the day-to-day lives of Medicaid recipients to produce serious potential consequences that have little to do with policy’s stated objectives.
Lack Of Awareness
Two thirds of the Medicaid recipients (12/18) I interviewed had not heard anything about the new work requirement. â€œFirst time Iâ€™ve ever heard anything [about it],â€� a 31-year old man, who had started a vocational training program the day we spoke, said. â€œYouâ€™d think itâ€™d be on the news or something. I ainâ€™t seen it on the news, and I watch Channel 8 news every night.â€�
At Risk Of Losing Coverage
Of the nine people who, based on their age, should have received a DHS letter letting them know they were subject to the work requirement, four said they had received a letter. Two said the letters indicated they were exempt because they already met the SNAP work requirement.
The other two were at risk for losing Medicaid coverage. One, a 47-year old woman, said she had received her letter about three months earlier; she believed, incorrectly, that she had three months to report her hours. When I asked her if reporting her hours was an obstacle, she said she was struggling with very stressful life issues, including a mentally ill sister, and as a result the work requirement had not received much of her attention. The other person, a 40-year-old woman, described being overwhelmed by receiving the letter: â€œBasicallyâ€¦ Iâ€™m like, okay, Iâ€™ve got this letter. I file it and I donâ€™t know what to do with it…â€�
The other five who should have received a work requirement letter were either not sure if the letter arrived or thought it had not. When asked about receiving a DHS letter, a 42-year-old woman said, â€œI donâ€™t know, Iâ€™m going to have to check and make sure [I didnâ€™t receive the letter], because I need my Medicaid card for my sugar pill and my blood pressure pills.â€� A 46-year-old man, who had recently completed an inpatient drug treatment program, kicking a multi-decade drug addiction, wasnâ€™t sure either. â€œI may have [received the letter]â€¦Iâ€™m horrible about opening mailâ€¦.I probably throwâ€™d it away.â€� While the three others did not believe they received the letter, they were all exempt by either working and/or having children in the home, but likely needed to report their hours and exemptions in the portal to maintain Medicaid coverage.
Policy Not Sparking Work-Related Changes
Of the nine participants who were likely subject to the policy, only two were not meeting the 80 hour work-related activity requirement and did not seem to qualify for an exemption. Both told me that they were actively seeking work, and that the work requirement had not at all impacted their job seeking. In addition, those I interviewed between the ages of 19-29, who will be subject to the policy in 2019, either worked, went to school, and/or had children under 18 years old in the home. No one I spoke with reported that the policy had or would spark them to change their work-related activities.
Online Portal Challenging For Many
Participants described a very wide range of computer and online skills and access. Approximately a third said that reporting hours on the online portal would not be possible for them: â€œI canâ€™t do that. I donâ€™t have a phone. I donâ€™t have a computer.â€�
Several, who were confident of their own skills, mentioned family members who would struggle. â€œHalf my family probably doesnâ€™t have a smart phoneâ€¦.A lot of people here donâ€™t have internet still,â€� a 19-year old woman explained.
Mixed Attitudes About Linking Medicaid And Work-Related Activities
Almost all the participants believed that people who could work should be working. â€œI believe if you are able to work and you want the extra help that Medicaid gives, then you should work,â€� said a 28-year old woman who was currently working and has young children. But several expressed concern about those who had mental or physical conditions that would prevent them from meeting the requirement. One man raised questions about people who were â€œborderlineâ€� who were not officially considered disabled but still had serious health conditions. A 42-year-old woman, who works with people with disabilities said, â€œI think itâ€™ll do more harm than goodâ€¦. What they supposed to do, just get cut off Medicaid because they canâ€™t meet those requirements?â€�
Others raised concerns about transportation needed to get to work and volunteering. â€œSome people donâ€™t have vehicles, and sometimes itâ€™s not necessarily their fault. Sometimes something happens and they lose their money… Itâ€™s not fair,â€� said a 21-year old recipient who is a college student. When I asked a woman who was looking for work whether she had tried to get help from the Department of Workforce Services, she said that she couldnâ€™t get there because it was 30 miles away and there is no public transportation.
Not Going To Lift People Out Of Poverty
Participants were very skeptical about the Governorâ€™s claim that the work requirement policy would help them out of poverty, as many were already working and still struggling financially.
One participant argued that the policy was not about getting people to work at all, but about reducing the number of Medicaid recipients: â€œIt seems like a ploy for the state to save money. Thatâ€™s all it is. Itâ€™s nothing about trying to get people back to workâ€¦â€�
Of the people I interviewed who were at risk of losing Medicaid coverage as a result of the work requirement, most were at risk because they lacked awareness of the policy or were overwhelmed by it, rather than because they were not meeting the 80 hours a month of work-related activities or the terms of an exemption. If this is true more broadly, the state will be ending peopleâ€™s health coverage for the wrong reasons, adding credence to those who argue this policy is about reducing the rolls, rather than supporting people to get employment.
A 38-year-old woman who recently had to quit her job to get her niece, who she mothers, a birth certificate and other paperwork to start school argued that the policy does not take into account the complex lives of low-income people. â€œYou are saying this should be possible, but you donâ€™t know my circumstances. You havenâ€™t been here,â€� she explained.
Dr. Jessica Greene is a Professor and the Luciano Chair of Health Care Policy at Baruch College, City University of New York.
Sometimes you simply do not need extensive health policy research to understand what impact various policy proposals would have. As an example, to understand what a work requirement to qualify for Medicaid would mean for the low-income, target population, just ask them.
This brief series of interviews of Medicaid beneficiaries done by Professor Jessica Green provides enough anecdotes that are fully predictable. This relatively unsophisticated, low-income population is already struggling with just trying to make ends meet. Throwing in an employment reporting requirement just further complicates their personal agendas. Besides, none of them believe that the program will cause them to change their work-related activities.
The purpose of Medicaid is to provide access to medical care for individuals who cannot afford it. Does requiring work as a condition of Medicaid enrollment advance that goal? No, just the opposite. Under this requirement many will lose their Medicaid coverage and thus lose access to medical care.
Look. We’re trying to get people the health care that they need. We already understand the policy decisions that would do that. A well designed, single payer, improved Medicare for all would take care of it. We do not need the injection of screwball ideas based on sterile ideology rather than benevolent compassion.
As one interviewee said, “you donâ€™t know my circumstances; you havenâ€™t been here.” But we do know how to get her and everyone else the health care program that they need. That’s what we need to be working on.
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Source: Finance Solidaire