New Medicaid Work Requirements Already Jeopardizing Thousands
Efforts by state and federal Republican lawmakers to scale back safety-net programs that support millions of families are reshaping health care and deepening the digital divide for low-income Americans. These lawmakers are limiting opportunities during a time of increasing inequality across the country.
Nowhere is this trend clearer than in states where President Trump is hugely popular, including Kentucky and Arkansas, where the president captured 62 and 60 percent of the vote respectively. In these states, access to Medicaid and Lifeline, an affordable internet program, are being stifled under the guise of innovation and cost-savings.
Last month, Arkansas implemented a work requirement for nearly 300,000 of its lowest-income adults enrolled in Arkansas Works, the state’s Medicaid expansion program. This new requirement — with the stamp of approval from the Trump administration — requires beneficiaries to report at least 80 hours of work or community engagement activities per month or risk losing access to essential medical services. The impact of this policy change is already staggering: 7,000 people didn’t meet the requirements in June and may lose their health coverage. A similar work requirement was recently blocked by a federal judge in Kentucky for being “arbitrary and capricious.”
The GOP’s obsession with tying work requirements to health-care access seems based on the idea that Medicaid recipients are out to game the system. In reality, the majority of non-disabled adult Medicaid beneficiaries already work at least part-time, according to the Kaiser Family Foundation. Yet, when this false perception is codified into law, as in Arkansas, the result can be catastrophic with penalties including loss of coverage and long waits for re-enrollment.
Arkansas’ reporting hardship is exacerbated by an unusual additional hurdle: Beneficiaries must report their activities exclusively through an online state web portal. State health officials frame the portal as a way to cut costs for the state’s Medicaid program and to improve the computer literacy skills of its beneficiaries. The problem? Many Medicaid enrollees in Arkansas either do not have access to the internet or have extremely limited access. They face a technological wall to reporting their work status. According to the Census Bureau, Arkansas has the second-lowest rate of home internet access in the country — only slightly above Mississippi.
Health policy experts and patient advocates have been critical of the state’s online-only requirement. Due to the lack of internet access in the state, Marquita Little, from the Arkansas Advocates for Children and Families, is concerned that many people do not know about the new work requirements. Furthermore, even those who do may not know how to accurately report their work, causing them to fall through the cracks and be locked out from health coverage.
Arkansas Medicaid beneficiaries without access to the internet could face serious consequences if they are unable to report their work or community engagement activities. If beneficiaries fail to report their work for three months, they will lose their Medicaid coverage for the remainder of that year. With limited incomes and a lack of options for subsidized care, they will become uninsured and lose access to care.
Arkansas’ Medicaid population will feel the squeeze even further. Lifeline is the federal program designed to increase access to affordable phone and broadband services for low-income families living below the poverty line. This program is also under threat by the Federal Communications Commission (FCC). The irony is that when FCC Chairman Ajit Pai visited Little Rock in April 2018, he acknowledged the tech barriers Arkansans face. As he put it, “There's no greater issue than closing the digital divide, the gap between those who have access to the internet and next generation technologies and those who don't.”
Dismantling Lifeline will eliminate subsidies and limit the number of times recipients can reapply for the program. It will also impede the ability of Medicaid recipients in Arkansas to comply with the state’s new work requirements, with 82 percent of the 84,000 residents on Lifeline left without a provider. Since Medicaid eligibility also qualifies individuals for Lifeline, these social safety net programs for millions of working class families are under open assault from all sides.
By putting in place burdensome Medicaid work requirements for recipients who already work, mandating online-only compliance reporting in a state with the second-lowest broadband access in the country, and making cuts to a program that helps poor families and individuals access the internet, state and federal officials have engineered major obstacles to essential health care.
With seven additional Medicaid work requirement waivers from states across the U.S. currently pending with the Trump administration, and Lifeline on the chopping the block, we urge state and federal lawmakers to think more critically about the compounding impact of their policymaking on vulnerable Americans. Unless fixed, these onerous regulations could prove disastrous for millions of families in need of health care. The stakes are simply too high.
Jason Resendez is a board member of Consumers for Quality Care and executive director of the LatinosAgainstAlzheimer’s Coalition. Carmen Scurato is vice president and general counsel of the National Hispanic Media Coalition.