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Medicaid work rules may cost 6,000 Arkansans coverage; Ohio waiver approved

More than 6,000 Arkansans are at risk of losing their Medicaid eligibility at the end of the month due to the state's Medicaid work requirements policy, according to a report from the Arkansas Department of Human Services.

A total of 6,472 people are at risk of losing their Medicaid coverage at the end of March, which would be the first group of people to lose coverage in 2019, according to a March 15 Arkansas DHS report. Under Arkansas' policy, someone loses Medicaid eligibility after not meeting the 80-hour-per-month work requirement for three months in a calendar year.

Controversy surrounded the Arkansas Medicaid program throughout the second half of 2018 when Arkansas became the first state to attach a work requirements policy to Medicaid, the joint state and federally run health insurance program for low-income Americans. The policy took effect in June 2018, and by December 2018, more than 18,000 people lost Medicaid eligibility.

The policy only applied to a portion of the state's Medicaid population in 2018 and will be phased in to include the entire population beginning Jan. 1. Health policy experts have suggested that this will lead to even more people losing coverage in 2019.

Eliot Fishman, the senior director of health policy at Families USA, a healthcare policy organization, told S&P Global Market Intelligence that up to 50,000 people could lose coverage in Arkansas in 2019.

The March report comes the day after Arkansas' policy was challenged in federal court for not upholding the principles of the Medicaid program. The plaintiffs cited throughout the hearing the thousands of people who lost coverage last year due to the new requirements.

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Judge James Boasberg for the U.S. District Court for the District of Columbia heard oral arguments March 14 for two cases challenging work requirements in Arkansas and Kentucky. Boasberg — who blocked Kentucky's policy from taking effect in June 2018 — said he will make his decision in both cases by the end of March.

Medicaid work requirements entered the national spotlight this week when the Trump administration proposed a nationwide work requirement as part of its fiscal year 2020 budget proposal. The idea drew criticism from Democratic lawmakers, who pointed to Arkansas' program as an example of the policy's failure.

The Centers for Medicare and Medicaid Services Administrator Seema Verma has continually defended work requirements in the past, despite the criticisms. On March 14, Verma published a blog post through CMS saying Medicaid waivers like work requirements are a way for states to experiment with new ideas that can improve Medicaid.

Ohio waiver approved

CMS approved Ohio's Medicaid work requirements waiver March 15. Ohio is the ninth state to receive approval from CMS to implement the policy. However, Maine Democratic Gov. Janet Mills rejected the agency's approval shortly after taking office in January.

Ohio Republican Gov. Mike DeWine praised the approval of the program in a March 15 statement.

"I am pleased that Ohio is a model state that balances a pathway to employment and access to healthcare in our reasonable work requirements," DeWine said. "They are intended to put those able-bodied adults served by the Medicaid expansion on a pathway to full employment."

Much like Arkansas, Ohio will require Medicaid recipients to work or participate in community engagement activities such as taking courses or volunteering for 80 hours a month. However, Ohio's penalty will kick in after someone does not meet the requirements for only one month.

According to Ohio's waiver, the state will then review the reasons the requirement was not met and either allow an exemption or create an alternative requirement for an individual. If the alternative requirement is rejected, the state will terminate an individual's Medicaid eligibility.