Courtesy: Arkansas Nonprofit News Network
Arkansas is the first state to implement a work requirement in its Medicaid program. Over the last three months, the state Department of Human Services removed some 12,277 people from Arkansas Works — the state’s Medicaid-funded insurance program for low-income adults — for not reporting at least 80 hours of “work activity” each month. The rule, which began for the first subset of beneficiaries in June, applies to able-bodied adults under age 50. Those who don’t comply for any three months in a calendar year are kicked off Arkansas Works and locked out until the new year begins. (Most Medicaid beneficiaries, however, are exempt from reporting.)
An October DHS report showed that among those required to report, only about one in nine did so. Some health advocates have expressed alarm at those numbers. On Nov. 8, the Medicaid and CHIP Payment and Access Commission (MACPAC), a nonpartisan federal advisory panel, sent a letter to Medicaid officials in the Trump administration calling for a “pause in disenrollments” in Arkansas. Commission chair Penny Thompson wrote that the low reporting rate may indicate some beneficiaries aren’t aware the policy applies to them or may be having trouble using the state’s website.
But even some who are well-equipped to navigate the new rule say it has disrupted their lives. Kadie Campbell, 38, is a resident of rural Washington County and a graduate student at the University of Arkansas; she’s on track to receive a master’s degree in clinical mental health counseling at the end of this semester. She’s been on Arkansas Works for a couple of years, she said, and until October she was enrolled in a Blue Cross plan paid for by Medicaid.
Campbell is considered a “full-time equivalent” student by the university. DHS says full-time students are exempt from the work requirement. But Campbell soon found she isn’t considered “full-time” by DHS, because she only spends three credit hours each week in a classroom. Her final semester of grad school is spent mostly in the field: She interns at a women’s prison, which she visits three days a week to conduct interviews with inmates, typically for five to six hours each day. She usually spends another 15-20 hours per week at home, reviewing videos from her interviews, doing paperwork and studying. She has to log at least 300 hours over the course of the semester, she said.
When DHS notified Campbell she’d have to begin meeting the work requirement in July, she first tried to claim the student exemption. “I put in that I’m full time — and for graduate students, this is full time — but their system doesn’t recognize that,” she said in a recent interview. “There’s not a distinction between undergrad and graduate work.”
So, she pieced together a plan. DHS counts every college credit hour for 2.5 “work activity hours,” meaning the three-hour class would give Campbell just 7.5 hours each week to count toward the work requirement. “I talked to my adviser and the professor, and we decided that the hours spent in the prison can be counted as volunteer work, but the hours I spend outside the prison doesn’t count for anything,” she said. (Each volunteer hour equals one “work activity hour” in the system.)
Manley, DHS spokeswoman, said a grad student’s internship hours would likely have to be entered in a separate education category. Such time might be considered “occupational training,” which comes with its own time multiplier. Campbell said she didn’t realize that was an option. She was simply following the rules regarding “college and university” hours on DHS materials.
Over the summer, Campbell picked up a part-time job at the Fayetteville Public Library working 16-20 hours per week. That wasn’t initially because of the work rule, she said; she needed the money. But she decided to keep working eight hours a week at the library even after the semester began, just to make sure she met the monthly requirement.
Though she found the work rules frustrating, Campbell studied them carefully. She knew she’d lose her insurance only after three months of noncompliance. She wouldn’t reach the requisite 80 hours per month in July or August, but she figured she’d be fine once the semester began.
“It was, I think, Sept. 28 that I got a notice from Blue Cross Blue Shield that my insurance was taken from me,” Campbell said. She was shocked. She’d been told she had until Oct. 5 to report her hours for September and had been waiting until she got her check from the library at the end of the month.
She called Blue Cross, which confirmed her insurance had been turned off due to the work requirement. She called DHS, which told her to call her county office. She called the Washington County DHS, which referred her back to the state. Eventually, she spoke to a supervisor in Little Rock who looked at her information and confirmed she only had two months of noncompliance and should not have lost coverage.
“She said it’s set up automatically so that if you haven’t entered anything by the 27th or 28th … the system automatically kicks you out,” Campbell recalled. “She just kept saying, ‘The system is new, and we’re trying to work out kinks, and there are people with problems.’ “
The DHS employee told Campbell she could immediately re-enroll but that she’d initially be covered through fee-for-service Medicaid, rather than Blue Cross.
“And I’m like, well, that’s great, but my mental health counselor doesn’t take Medicaid,” Campbell said. She was told she should be able to re-enroll in Blue Cross in December or January. Until then, her counselor has agreed to see her pro bono, which she’s thankful for. (“As a clinical mental health graduate student interning at a women’s prison, it’s pretty important that I have my own counseling,” she added.)
Manley said the work requirement shouldn’t trigger a closure before the last day of the month. Asked by email whether beneficiaries have been accidentally disenrolled after only two months of noncompliance with the work requirement, she replied that “no known instances of this have occurred.” However, Campbell provided a screenshot of the Access Arkansas portal showing that she’d been noncompliant for just two months as of November, along with letters from Blue Cross notifying her that her plan would be closed at the end of September.
“I really don’t understand why things happened. I just know that they did,” Campbell said. “I think that it’s messed up and it’s wrong and my coverage was taken from me unfairly. I have met every requirement and I have actually gone above and beyond.”
She also wonders if other low-income Arkansans are falling through the cracks. “I have the luxury of being able sit around on the phone for as long as it takes to get ahold of somebody — and being eloquent enough to explain my situation,” Campbell said. “I’m savvy with a computer system. I’m working diligently to become a productive member of society. … If I’m getting screwed, then how many other people are?”
Editor’s Note: This reporting is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project in Little Rock dedicated to producing journalism that matters to Arkansans.
Courtesy: Arkansas Nonprofit News Network