Thousands Lose Medicaid as Arkansas Implements First 1115 Work Requirement Waiver

It’s 7am and I’m sitting in bed with too many beverages (coffee, water, smoothie–gotta get those leafy greens in) and too many tabs open (embryology review, TeamRads, Twitter, and multiple newspaper homepages). And oh yeah, my second anatomy exam is this afternoon.

But what I’m actually stressing about how thousands of low-income Arkansas residents no longer have Medicaid coverage. 

The ACA allowed states to expand Medicaid coverage for childless adults over the poverty line, including individuals and a family of four with an annual income up to $16,000 and $34,000, respectively. Arkansas is one of 33 states and the District of Columbia that expanded Medicaid. Nearly 30 percect of Arkansans are covered by Medicaid. But Arkansas is one of four states with an approved Section 1115 waiver that conditions Medicaid eligibility on employment and reporting requirements–and it the first state to implement such a waiver. [The Kentucky work requirement waiver is currently on hold while it is litigated after it was determined that an estimated 95,000 Kentuckians would lose Medicaid coverage.]

While Arkansas claims to have done extensive outreach to affected Medicaid recipients by mail, phone, and email, it is alarming that 4,350 of 60,000 individuals subject to the requirement have still lost medical coverage. [It seems statistically impossible that all 4,350 people have moved to new addresses, have new phone numbers, or don’t read their mail or email.] The waiver stipulates that enrollees lose coverage for the rest of the calendar year if they are non-compliant with the reporting requirement for three months. So these 4,350 individuals are barred from re-applying for Medicaid until January 2019. An additional 5,076 individuals have two months of non-compliance and 6,174 have one month of non-compliance–they also risk losing coverage without a chance to re-apply until January 2019 if they do not comply.

In a state where one-fourth of the population lives in an area without internet access–including Lee County in which three-fourths of the residents do not have internet access–it is appalling that the state claims good faith outreach and then implements a system that requires people to report their work hours or apply for an exemption VIA THE INTERNET. There is no in-person or mail option. In addition to this obvious barrier to retaining coverage there is also this gem–the reporting system is offline daily between the hours of 9pm and 7am.

From a public health perspective, Medicaid is a vital for keeping individuals and communities healthy. In 2016, Arkansas reported 623 deaths from influenza/pneumonia–the 8th highest rate in the nation. Losing Medicaid coverage now with no chance to reapply until January 2019 means that thousands of Arkansans will not have access to a free flu shot. It might lead to high rates of infection and death from influenza this year.

In addition to high rates of death from influenza/pneumonia, Arkansas ranks 3rd for deaths from heart disease, 4th for deaths from kidney disease, and 5th for deaths from stroke, cancer, and chronic lower respiratory diseases. Kicking low-income individuals off of a program proven to improve health outcomes will only stack the deck further against the most vulnerable in Arkansas for generations to come. While Medicaid was created as a joint federal-state partnership that gives states ample room to experiment, it should not come at the expense of access to care and positive health outcomes of its beneficiaries.

Image from via Bloomberg News.


  1. […] Instead of implementing Medicaid work requirements (which are onerous and don’t work!), Pennsylvania is connecting interested folks to employment training programs upon Medicaid enrollment. [States currently seeking to implement work requirements would require proof of employment to remain insured on Medicaid. It has not gone well in Arkansas.] […]


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