In a letter to U.S. Department of Health and Human Services Secretary Alex Azar, the head of a congressional advisory committee asked that Arkansas stop disenrolling people from Medicaid for not meeting the state's new work requirements.
Penny Thompson, chair of the Medicaid and CHIP Payment and Access Commission, or MACPAC, a non-partisan congressional advisory committee, said in the Nov. 8 letter that the commission is "highly concerned" about the 8,462 people who have lost eligibility until 2019 and asked Azar for a temporary stop to banning people from the program for not meeting work requirements.
"The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail," Thompson said. "As a result, the Commission calls for a pause in disenrollments in order to make program adjustments to promote awareness, reporting, and compliance."
Caitlin Oakley, a spokesperson for HHS, confirmed in a Nov. 9 email that the agency has received the letter, and will carefully review and respond. Oakley did not say if HHS is currently considering putting a hold on Arkansas's program.
Arkansas is the only state to have a work requirements program implemented. It went to effect in June and requires that an individual work or participate in community engagement requirements like school or volunteering for 80 hours a month. If three total months in the year are missed, the beneficiary loses eligibility until 2019.
So far, 8,462 people have lost eligibility and another 4,841 were at risk of losing coverage at the end of October.
Cindy Gillespie, director of the Arkansas Department of Human Services, told S&P Global Market Intelligence in October that there are no plans to stop or pause the program, regardless of how many people lose eligibility.
A spokesperson for the Arkansas DHS said that the Centers for Medicare and Medicaid Services "has not asked us to, nor do we have plans to, pause the program."
Dawn Stehle, deputy director for health and Medicaid director for the Arkansas DHS, criticized MACPAC in an Oct. 31 letter to Thompson for a presentation made to the commission about Arkansas's program. Stehle said facts in the presentation were inaccurate and the presentation was done with the participation of Arkansas DHS. Stehle also criticized MACPAC for suggesting that the program be suspended or terminated.
"For MACPAC to attempt to establish itself as a monitor over individual state Medicaid programs is a new and slippery path that should be reconsidered," Stehle wrote.
One of the concerns highlighted by Thompson is that beneficiaries are required to report online despite the state's internet connectivity issues, which has been a top complaint from critics of the program since it took effect.
Gillespie has pushed back against this criticism in the past, claiming that there are multiple options for people to utilize if there are problems registering or if the beneficiary does not have internet access. However, Thompson said the state was unable to provide MACPAC with any figures about how many people have used these services.
Thompson also said beneficiary awareness was another main concern because many of the educational services available to people are only online or through social media. The commission also critiqued the short time frame between the program's approval and implementation.
The letter clarified that MACPAC "is not commenting here on the merits of work and community engagement requirements."
Kentucky was the first state to receive approval from CMS for a work requirements program, but it was blocked by a federal judge in June for not taking into account that 95,000 people could lose coverage if implemented. Arkansas has a similar lawsuit filed against it, which is being overseen by the same judge who issued the Kentucky ruling.
Other than Arkansas, four states have had work requirements approved and nine currently have applications pending with the Centers for Medicare and Medicaid Services, according to the Kaiser Family Foundation.