On June 1, 2018, Arkansas will be the first state to begin implementing work requirements in its Medicaid program. The new requirements stem from guidance from the Centers for Medicare & Medicaid Services that paved the way for states to make “work or other community engagement” activities a condition of Medicaid eligibility.
Who could be affected, and what do we know about them?
This report assesses the size and composition of Medicaid enrollees in Arkansas who could be affected by the program’s new work and community engagement requirements. We divided the state’s nonelderly, nondisabled adult Medicaid enrollees into three groups: (1) those who would likely be exempt from work requirements, (2) those who could be subject to work requirements and are working, and (3) those who could be subject to work requirements and are not working.
For each group, we assess reported socioeconomic characteristics and serious health limitations that might limit enrollees’ ability to work or their ability to document qualifying exemptions or completed work hours. Enrollees in all three groups could be at risk of losing Medicaid coverage because of the new work requirements, but the third group faces the greatest risk.
Given the exemptions Arkansas plans to implement, we find that in 2018, 86 percent of nonelderly, nondisabled adult Medicaid enrollees would likely be exempt from work requirements, a share that includes adults ages 19 to 29. In 2019, when nonelderly, nondisabled adult enrollees ages 19 to 29 will no longer be exempt from work requirements, the estimated share in the likely exempt groups decreases to 74 percent.
• An estimated 269,000 nonelderly, nondisabled adults were enrolled in Arkansas’s Medicaid program in 2016. In 2018, when adults ages 19 to 29 are exempt from the work requirements, we estimate that 230,000 enrollees (86 percent of the enrollee group) would likely be exempt from the work requirements; 17,000 (6 percent) could be subject to work requirements and are working; and 22,000 (8 percent) could be subject to work requirements and are not working.
• In 2019, when adults ages 19 to 29 are no longer exempt from work requirements, we estimate that 198,000 enrollees (74 percent of the enrollee group) would likely be exempt from work requirements; 31,000 (12 percent) could be subject to work requirements and are working; and 39,000 (15 percent) could be subject to work requirements and are not working.
• Among those potentially subject to work requirements who are already working, an estimated 32 percent did not work at least 48 weeks and 20 hours a week in the past year and thus would not meet the state’s work requirements throughout the entire year. In the weeks they worked, these enrollees averaged 35 hours of work a week, exceeding the 20-hour-a-week average that Arkansas would require over a year.
• Enrollees who are potentially subject to work requirements and are not working are predicted to be at the highest risk of losing coverage once work requirements are implemented. Seventy-eight percent of these enrollees have at least one of the following attributes: no access to a vehicle in their household, no access to the internet in their household, less than a high school degree, a serious health limitation, or a household member with a serious health limitation. Some people in this group have characteristics that could make it difficult for them to comply with work requirements, especially if the state does not make new investments in job training, job search assistance, employment supports, and related services.
• Unless they are exempt from reporting their hours, Medicaid enrollees subject to work requirements in Arkansas will be required to document work-related activities online only. But 31 percent of enrollees potentially subject to the work requirements and not working have no access to the internet in their homes.